Anti-Money Laundering – Client Due Diligence – Governing Data Exchange

Anti-Money Laundering - Client Due Diligence

Required in accordance with the Data Protection Act 2018 (DPA 2018) and anti-money laundering compliance with HM Revenue & Customs

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Title *

Name *

First

Last

Have you ever used a different name? *

Former Name *

First

Last

Gender *

Marital Status *

Date of Birth *

Country of Residence *

Nationality used Marital

Please state Country of residence *

Are you a politically exposed person (PEP) or potentially a PEP? *

Nationality *

Occupation *

National Insurance Number (NINO) *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Phone *

Identity Evidence *

Current Valid Signed Passport
Valid Photo-card Driving License
National Identity Card
Firearms Certificate or Shotgun License
Military Services Identity Card
Residence Permit Card
Other (Custom Type)

A valid photo identity is required, please upload document in the section below.

Enter Custom I.D Name *

Upload Photo Identity *

Click or drag files to this area to upload. You can upload up to 2 files.

Sources of Wealth and Funds *

Self - Employment Income
Employment Income
UK Land & Property Income
Capital Gains Made in Year
Base Cost/Improvements and Sale/Purchase Cost Information
Savings Interest
Dividend Income
Foreign Income
PPI Repayments or Compensation
Other (Custom Name)

Please select all relevant sources of income

Enter Custom Name for Source of Income *

As per GDPR regulations, I understand that by ticking the box below, I am providing consent to allow my information to be held on file *

I provide consent

I herby confirm that the data provided is correct and accurate *

I provide consent to the use and processing of my data

Signature

Clear Signature

Additional Information

AML 5.0 Integration Fee *

Price: £60.00

Please note that a one-off integration fee is required in order to complete the anti-money laundering checks and client due diligence report

Card Payment Details *