Client Proof of Identity Form (Italian Residents)

Client Proof of Identity, AML and Data Protection Procedures

First Name*

E-mail:*

Middle Name(s)

Phone (primary)*

Fiscal Code Number (Italy)*

How would you like to be addressed?

Fields marked with an asterisk must be completed

Last Name*

Occupation

Date of birth*

Phone (2)

Website

1/5

Are you signing up of behalf a company, partnership or other legal entity*

Yes

Name of Company

Your title or job function

Company Registered Address

Street Address Street Address Line 2 City State Postal / Zip Code

Country of VAT/Business Registration

VAT Number or Business ID Code*

2/5

Please insert your residential address (as shown on your ID card).

Address

Street Address Street Address Line 2 City State Postal / Zip Code

Country

3/5

ID Card Number*

Town/State of Birth*

Country of Birth

Please attach a legible copy of the front and back of your Italian ID card. Please click on the arrow below to choose your file.*

Country of Citizenship

Do you have another nationality?*

Yes

Second Country of Citizenship

Please attach a copy (front and back) of your Italian healthcare card (Tessera Sanitaria) or other document showing your Italian fiscal code number

Date of issue dd/mm/yyyy*

Date of expiry dd/mm/yyyy*

4/5

In pressing the "Submit" button, I confirm that I have fully read and accept the terms and conditions for the services the firm will provide me and especially the following clauses:

Clause 4 - Timing for payment of fees and right to retain documents pending payment;
Clause 8 - Disbursements and expenses for contentious matters;
Clause 10 - Ending our services;
Clause 18 - Limitation of liability.

I confirm that I have read the privacy policy and agree that you will deal with my personal data in accordance with that policy.

I further confirm that I have read and accept the anti money laundering policy and that am not involved in money laundering, nor am I involved in anyway with laundering the proceeds of serious crime, or with terrorist activities. I have read and accept the firm's Equality and Diversity Policy

Are you a Politically Exposed Person (PEP). This is defined as:
a Government Official;
a Political Party Official;
a Senior Government or Political Party Executive; or
a Spouse/Partner/Relative/Close Associate of the same.

(PEP)*

I am not a politically exposed person

I am a politically exposed person

5/5

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Client Proof of Identity Form (Italian Residents)

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