Register

KYC APPLICATION:

Username

Corporate Name:

First Name

E-mail Address

Business Type:

Address:

Mob:

Owners Name(s):

Last Name

Password

Confirm Password

Regulated By:

Tel:

Fax:

License No.:

Minerals Mining Operator:

Name

Position:

Passport No.:

Email:

Tel:

Minerals Refinery:

Name:

Position:

Passport No.:

Email:

Tel:

Minerals Seller/Broker:

Name:

Position:

Email:

Tel:

Passport No.:

KNOW YOUR CUSTOMER (KYC) FORM STRICTLY CONFIDENTIAL

20. Copies* of Customer Identification Documents
Please submit the documents and tick (x) against the documents attached
(i)	Individual	ID Card/Passport/Driving License (DL)	Proof of Domicile Country**
(ii)	Company	Company Registration	List & Passport copies of Authorised Signatories
		Major Shareholders:	List of Major Shareholders
		Shareholders who, directly or indirectly	List & Proof of Domicile Country** of Directors
		owns or controls more than5% of the shares or voting rights
(iii)	Partnership	Certificate of Registration	Partnership Deed
		List & Passport copies of Authorised Signatories	List & Proof of Domicile Country** of Partners
(iv)	Trust	Certificate of Registration	Trust Deed
		List & Passport copies of Settlor, Trustees, Protector	List & Passport copies of Authorised Signatories
			List of Major Beneficiaries
		Major Beneficiaries:	Beneficiary who is to receive at least 25% of the funds of the Trust
(v)	Any other Legal Person	Registration Document	List & Passport copies of Authorised Signatories
		List of the Individuals/Entities who ultimately owns, or exercises effective control over such person
Declaration
I/We hereby confirm that the above information provided to you is true and correct to the best of our knowledge. I/We acknowledge that if the information provided is found to be false or misleading then the business relationship may be annulled anytime at your discretion. I/We hereby agree to provide any additional information/documentation that may be required.

Date:

Signature of Authorised Signatory

Upload

*Certified copies of documents clearly signed, stamped and dated by any of the following: -
(1) A representative of an embassy, consulate, or high commission of the country; or (2) A lawyer or attorney; or (3) A notary public or commissioner of oaths; or (4) A chartered or certified accountant.

Upload

The date of signatory should not be older than 3 months. Copies of certified copies is not acceptable. **Any document to show the residential address like utility bill, tenancy agreement
Copies of certified copies is not acceptable.
**Any document to show the residential address like utility bill, tenancy agreement

Any of the above information that does not fit into the allocated column should be presented below or other information you may wish to disclose:

Only fill in if you are not human

KYC APPLICATION:

KNOW YOUR CUSTOMER (KYC) FORM STRICTLY CONFIDENTIAL

20. Copies* of Customer Identification Documents

Services

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