Client Sign-Up Form

Client Proof of Identification and AML Requirements

First Name*

Middle Name(s)

Last Name*

Date of birth*

Phone (primary)*

Phone (2)

Fields marked with an asterisk must be completed

How would you like to be addressed?

E-mail:*

Occupation

Website

Fiscal Code Number (Italy)*

Taxpayer Identification Number/UTR

National Insurance Number

1/5

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

Yes

Name of Company

Your title or job function

Country of VAT/Business Registration

List of Countries

VAT Number or Business ID Code*

2/5

Address

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

Country

Second Address

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

Second Country

3/5

Passport/ID Card Number*

Town/State of Birth*

Date of issue dd/mm/yyyy*

Please attach a copy of the information/photo page of your passport or ID card. Please click on the arrow below to choose your file.*

Please attach a copy of another form of ID, showing your residential address. This can be a recent (<3 months) utility bill, driver's licence, bank statement, certificate of residence or tax notice, as long as it shows the residential address you gave on the previous page. Click on the arrow below to choose your file*

Do you have another nationality?*

Yes

Do you want to upload another document?

Yes

Please attach your third document. Click on the arrow below to choose your file

Country of Citizenship

Country of Birth

Date of expiry dd/mm/yyyy*

Second Country of Citizenship

4/5

In pressing the "Submit" button, I confirm that I have fully read and accept the terms and conditions for the services the frim we 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