Return to Due DiligenceFiscal Services Limited
IDENTITY VERIFICATION FORM ~ TO BE COMPLETED BY THE CUSTOMER
Date ...................................................................................................
To ...................................................................................................(Name of your Bank)
...................................................................................................(Address of your Bank)
...................................................................................................(Address of your Bank)
Dear Sirs
Request for verification of customer identity
In accordance with Proceeds of Crime (Money laundering) Code 2010 and the Prevention of Terrorist Financing Code 2011, we write to request your verification of the identity and opinion of our prospective customer stated below.
Full name of customer ...................................................................................................
Title (Mr / Mrs / Miss / Ms) Please delete as applicable
Address ...................................................................................................
...............................................................................................................
Post Code ...................................................................................................
Account No (if known)...................................................................................................
Date of Birth ...................................................................................................
I hereby agree that Fiscal Services Limited may obtain whatever references they deem necessary to satisfy their account opening documentation requirements and also authorise you to debit my/our account with any such charges levied in this regard
Customers signature ...................................................................................................
To be completed by the Bank
We confirm that the above customer *is/is not known to us
Date account opened ....................................................................
*We confirm/cannot confirm the address as shown in your enquiry
*We confirm/cannot confirm that the signature reproduced in your enquiry appears to be that of the above customer
*We confirm/cannot confirm that the above customer is considered respectable, trustworthy and suitable to conduct all normal stockbroking business
The above is given in scrict confidence, for your private use only, any without any guarantee or responsibility on the part of this Bank/Building Society* or its officials.
*Delete as appropriate
Signed ...................................................................................................
Name (print) ...................................................................................................
Job Title ...................................................................................................
Bank Stamp
As this request has been authorised by your client, we would be obliged if you would respond positively and promptly by returning the completed form as soon as possible.
________________________________________________________________________________
Fiscal Services Limited
7 Hill Street
Douglas
Isle of Man
IM1 1EF
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Phone: +44 (0)1624 670022 - Fax: +44 (0)1624 672504
e-mail: mail@fiscalservices.co.im
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