1111111111111111111CLIENT
COMPLIANCE APPLICATION
Insert Client Letterhead Here
1.
PROGRAM
CONFIRMATION
I ______________________________________(Insert First and Last
Name) residing at address:______
_____________________________________________City____________________
State___________
Country:____________________________________________________________________________
hereby confirm the following:
A.
Program
Confirmation
I would like to apply
for enrolment and acceptance into the following selected program:
[X]
Owned Instrument with a value of $ 18,000,000.00 (Eighteen Millions US$)
The Instrument is a [ X ] BG / [ ] SBLC / [ ] MTN / [ ] LTN
The Instrument
Currency is [ ] Euro / [ X] USD / [ ] GBP / [ ] Other ______________Specify
The Instrument
Issuing Banks Name is:_____________________________
Bank Country:____________
I, (INSERT YOUR NAME), hereby declare with full
personal and corporate responsibility under penalty of perjury that the
information given here is true and correct, genuine and accurate.
By: (INSERT
YOUR NAME)
Signed____________________________________________
Date_____/_____/_____
Title_________________________________
Passport Number ___________________
Insert Client Letterhead Here
2.
ELIGABILITY DECLARATION
I ______________________________________(Insert First and Last
Name) residing at address:______
_____________________________________________City____________________
State___________
Country:____________________________________________________________________________
hereby confirm the following:
Neither I or any person
or company I represent is in ANY of the following categories that Secure
Platform Funding will NOT provide service to:
- USA Passport Holders
- USA Corporations
- Clients that Reside in the USA
- Businesses with Head Offices in the USA
- Clients utilizing USA Bank Accounts for any part
of their transaction with us.
We DO NOT provide ANY services to Passport holders or Businesses
from the following countries:
- Afghanistan
- Libya
- North Korea
- Sudan
- Syria
- Yemen
I, (INSERT YOUR NAME), hereby declare with full
personal and corporate responsibility under penalty of perjury that the
information given here is true and correct, genuine and accurate and I am not
in any of the categories or groups listed above.
By: (INSERT
YOUR NAME)
Signed____________________________________________
Date_____/_____/_____
Title_________________________________
Passport Number ___________________
Insert Client Letterhead Here
3.
CLIENT INFORMATION SHEET
In
accordance with Articles 2 through 5 of the Due Diligence Convention and the
Federal Banking Commission Circular of December 1998, and under the US Patriot
Act of 2002, as amended in February 2003 concerning the prevention of money
laundering and 305 of the Swiss Criminal Code and Anti Money Laundering Act,
the following information may be supplied to banks and/or other financial
institutions for purposes of verification of identity and activities of the
Client described below, and the nature and origin of the funds which are to be
utilized. The foregoing is subject to agreement by all parties to whom this
information is provided that they are obligated to respect the privacy rights
of the Client and all individuals described herein, as well as the generally
accepted professional standards relating to the maintenance of confidential
information, and to take all appropriate precautions to protect the
confidentiality of the information contained herein, This legal obligation
shall remain in full force indefinitely without restriction.
Corporate
Full Name of Institution :
Registration Number :
Date of Registration :
Domicile /Jurisdiction :
Postal Address :
Registration Address :
Physical Address :
(if different from Registration Address)
Business Telephone Number :
Business Facsimile Number :
E-mail Address :
Website :
Corporate Officer 1 and Title :
Corporate Officer 2 and Title :
Business Trading Type / Description
:
Insert Client Letterhead Here
Details of Signatory to Contract ? Corporate & Individual
First Name :
Last Name :
Date and Place of Birth :
Nationality :
Passport Number :
Date of Issue of the Passport :
Expiry Date of the Passport :
Title in the Corporation :
Mobile Phone Number :
Home Address :
Home Telephone Number :
Home Facsimile Number :
E-mail Address :
Legal Advisor Name :
Legal Advisor Address :
Legal Advisor Telephone Number :
Legal Advisor Facsimile Number :
Do you speak English? :
If no, what language? :
If English is not listed, please provide the name and co-ordinates
of a person you designate to translate from English to your preferred language.
Translator Name :
Translator Address :
Translator Telephone Number :
Translator Facsimile Number :
Translator E-mail Address :
Details of the Bank Account ? From Where your Instrument is held/issued
Bank Name :
Bank Address :
Bank Swift Code :
Account Name :
Account Number :
Account Signatory Name and Title :
Bank Officer Name and Title :
Bank Officer Telephone Number :
Bank Officer Facsimile Number :
Bank Officer E-mail Address :
Insert Client Letterhead Here
4. DECLARATION OF NON SOLICITATION AND FUNDS OWNERSHIP
I, (INSERT YOUR NAME)
warrant and attest, with full personal and corporate responsibility that as the
beneficial owner; I have full legal title and authority with no governing
restrictions over the herein described Bank Instrument.
We hereby grant THE TRANSACTING
PRINCIPALS and/or Secure Platform Funding full permission and authority to
verify, confirm, and reconfirm said collateral and/or assets on a bank-to-bank
basis and conduct standard background checks of the collateral and/or assets,
and the corporate entity owning such.
I
warrant and attest that I have not authorized or offered to any other party,
consultant, broker or investor the placement of the collateral and/or assets
defined herein nor have I shopped the collateral and/or assets to any other
financial broker, consultant or company in the last 8 weeks.
I certify and attest that at no time has
your organization or any agent and / or appointee on your behalf made any offer
or solicitation.
I, (INSERT YOUR NAME) attest and warrant with full
responsibility under the penalty of perjury that:
a)
The
available Bank Instrument listed in this Application is from good, clean,
cleared sources, free
and clear of security interests or similar interests of any kind or nature
whatsoever.
b)
I
or the company I act for are the full owner or beneficiary of the Bank
Instrument.
c)
The
Bank Instrument has been legitimately earned and obtained from non-criminal
& non terrorist origins.
d) The Bank Instrument is free and clear of any
liens or encumbrances and the Bank Instrument is under my control, immediately
available and freely transferable without consent of any third party.
e) The Bank Instrument are legally earned, taxed,
and include no independent third-party interests.
f) The Bank Instrument owner and beneficiary are not a party to a law suit
or pending adverse legal action, further, there are no pending contracts
existing, or about to exist, that could affect the said Bank Instrument.
g) All information supplied in
the documentation submitted with this Application and the Bank Instrument involved, are not in violation of the
Patriot Act of October 26, 2001, and amendments thereto, with its related
financial crimes counterparts however interpreted, defined and enacted, whether
within the United States or any other international jurisdiction.
I, (INSERT
YOUR NAME), as Account Holder and duly Authorized Signatory, do hereby confirm
that I have requested of you and your organization, specific confidential
information and documentation on behalf of myself regarding currently available
Private Financial Opportunities to serve only my interest, education, and not
for further distribution.
I hereby agree that all information received from
you is in direct response to my request, and is not in any way considered or
intended to be a solicitation of any sort, or any type of offering, and for my
general knowledge only. I hereby affirm under penalty of perjury, that I
have requested this information from you and your organization of my choice and
free will and further, and that you have not solicited me in any way.
I hereby represent that I am
not an informant, nor am I associated with any government agency of the United
States of America, or any other country, such as the Secret Service, Internal
Revenue Service, Federal Bureau of Investigation, Central Intelligence Agency, Securities
and Exchange Commission, Banking Commission, Interpol, any countries Financial
Market Authority, nor any agency whose purpose is to gather information
regarding such transactions or offerings.
I understand that any contemplated transaction is strictly
one of a private nature, and is in no way relying upon, or relating to, the
United States Securities Act of 1933, as amended, or related regulations, and
does not involve the sale of public securities.
Further, I hereby declare that you have disclosed
that you are not a licensed security trader, attorney, bank officer, certified
public accountant or financial planner. Any information, work or service
conducted hereunder is that of a private individual and that this is a project
funding transaction that is exempt from the Securities Act and not intended for
the general public but Private Use only.
I acknowledge that submission of this application
is no guarantee of acceptance, that no reason for being declined needs to be
given, nor do I have a right to appeal any decision. I agree that regardless of
the outcome with my application I will not to make any negative public or
private statement either in writing or verbally to any other party, website,
media company or person.
The electronic or facsimile transmission of these
documents shall be considered a binding and enforceable instrument,
treated as original copy. Original may be obtained upon request.
I, (INSERT YOUR NAME), hereby declare with full
personal and corporate responsibility under penalty of perjury that the
information given within this application true and correct, genuine and
accurate, that I have had the opportunity to consult appropriate professional
accounting and legal advice and that I have read and voluntarily agree to all statements
in this documentation without reservation or hesitation.
By: (INSERT
YOUR NAME)
Signed____________________________________________
Date_____/_____/_____
Title_________________________________
Passport Number ___________________
Insert Client Letterhead Here
5. BOARD OF DIRECTORS CORPORATE RESOLUTION
A special meeting of the Board of Directors of (Company Name)
(hereinafter referred to as ?Corporation?) was duly held in accordance with the
Articles of Association/By Laws of the Corporation on the ___/___/___
Present at the meeting were the following
Directors: ____________________________
______________________________________________________________________
The meeting of the Directors undertook the
following Corporate Resolution, which has been recorded in the Minute of the
Book of the Corporation.
It was unanimously resolved to utilize the (BG, SBLC, MTN, LTN) Bank
Instrument with a value of ___________________________________________
on deposit at (Bank Name) for an investment,
monetization, sale, trading or private financial opportunity.
Additionally it was unanimously resolved, that Authorized Persons Name
of the Corporation who is the authorized signatory of the (BG, SBLC, MTN, LTN) Bank Instrument, is authorized to use the
full companies corporate authority, to enter into instrument monetization, sale,
trading and fee agreements as necessary, to make selections as to which
investment, monetization, sale, trading or private financial opportunity will
best suit the placement of these funds/assets so as to assure the anticipated
financial returns and to receive and distribute all profits from the investment,
monetization, sale, trading or private financial opportunity.
The necessary authority and powers required to
undertake these tasks and responsibilities are hereby granted to:
Name :__________________________________________________
Passport No. :__________________________________________________
Country of Origin :__________________________________________________
It is therefore, unanimously resolved that the
appointed officer above shall have the authority to negotiate all details and
sign the final contract with the officer representing the investment,
monetization, sale, trading or private financial opportunity and associated authorities
or bank officers.
There being no further business, the meeting was
declared adjourned, and in witness thereof, the directors signed below on the
date first written above.
Signed and sealed this date of ___/____/____
Signature:__________________________ Full Legal Name:_____________________
Title:______________________________ Passport # :_________________________
Passport Issuing Country:_____________________________
Insert Client Letterhead Here
6.
PASSPORT
Insert Full
Color Photo of your Passport Here
|
I, (INSERT YOUR NAME), hereby declare with full
personal and corporate responsibility under penalty of perjury that the passport
above is mine and is true and correct, genuine and accurate.
By: (INSERT
YOUR NAME)
Signed____________________________________________
Date_____/_____/_____
Title_________________________________
Passport Number ___________________