KYC (Know Your Customer) Form Note: Use N/A if not applicable Full Company Name Your Business Address Office No Building Name Street Address City State Country Pin/Zip/Code/P.O.Box Please state below the details of the owners/partners/managers of the Company. Full Name Nationality Contact No. Email Address Full Name Nationality Contact No. Email Address Full Name Nationality Contact No. Email Address Group Company Information Name of Company Nature of Association Name of Company Nature of Association Name of Company Nature of Association Trade License Details Issuing Authority License No. Issue Date Expiry Date Product Registration Details Reg. No. Expiry Date Commercial Registration Details Reg. No. Expiry Date Other Registration Status Has your business or has any of its Directors, Principals, or Partners been: Currently under any legal proceedings or pending judgment in the Court of Law? Yes No Convicted of or charged with a criminal offense in past 3 years? Yes NO Found liable for negligence, fraud, wrongful trading, or malpractice? Yes No Subject to any application for, or declaration of, liquidation, bankruptcy, or similar proceedings or subject to an administrative order? Yes No Refused license or authorization to conduct business has been suspended, withdrawn, or not renewed? Yes No Censured, fined, disciplined, suspended, or refused membership by any regulatory body? Yes No Company Legal Information ( please mention details as applicable) Company incorporation/Registration Certificate Date/year of incorporation Doc No. VAT Registration No. Tax Reg No GST Registration No Other PAN No of Co. Trade License No Business Reg Certificate Cert. of incumbency Doc No. Valid till Industry/Association Membership No (Bourse Membership or Diamond Association Membership) Source of funds Purpose of transaction Company directors Share Holder(s) Manager Authorized Signatory Name Email Designation Mobile No Emirates ID Director Identification No Passport No ID Valid Till Date Other Document (Please Specify) Ultimate Beneficial Owner Name/ declaration *Attach Latest Govt./Authority/Share certificate for UBO(s)-1st level & identity proof Name of the Person Share % Identity No.(Attach Doc.) ID Type: Passport/PAN/Aadhar/Other Name of the Person Share % Identity No.(Attach Doc.) ID Type: Passport/PAN/Aadhar/Other Name of the Person Share % Identity No.(Attach Doc.) ID Type: Passport/PAN/Aadhar/Other Bank Details Bank Name and Address Bank Account Number RTGS/SWIFT Code IBAN No Account Type/Currency Correspondent Bank Name and SWIFT Code Attach all documents please Drag & Drop Files Here or Browse Files Encl: Documents Attached for above KYC/KYS Trade License copy Company Pan Card copy Latest Certificate of Incumbency Business Registration Certificate VAT Registration Certificate GST Registration Certificate TAX Registration Certificate Copy of shareholders /Directors/Manager---Passport Visa (if applicable) Emirates ID Other ID(Pl. specify) MOA and AOA Partnership Document (If partnership firm) Share Certificat Extract of Company Certificate of Registration Certificate of Incorporation Sign Here Send
