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    Source of Wealth - NETELLER

    Uploaded by

    Tahsin Ove
    This document is a source of wealth declaration form for a NETELLER account. It requests the account holder provide their name, nationality, occupation, annual income, and residential address. It asks the account holder to declare the source of wealth for funds in their NETELLER account is from salary/self-employed income, assets/investing/trading, or other. It also requires the account holder confirm the information is accurate and select supporting documents to evidence the source and volume of funds, such as pay slips, bank statements, investment certificates, or other documentation. The completed form must be e-signed and returned.

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    © All Rights Reserved
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    Source of Wealth - NETELLER

    Uploaded by

    Tahsin Ove
    936 views2 pages
    This document is a source of wealth declaration form for a NETELLER account. It requests the account holder provide their name, nationality, occupation, annual income, and residential address. It asks the account holder to declare the source of wealth for funds in their NETELLER account is from salary/self-employed income, assets/investing/trading, or other. It also requires the account holder confirm the information is accurate and select supporting documents to evidence the source and volume of funds, such as pay slips, bank statements, investment certificates, or other documentation. The completed form must be e-signed and returned.

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    NETELLER - Source of Wealth PDF Form

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    This document is a source of wealth declaration form for a NETELLER account. It requests the account holder provide their name, nationality, occupation, annual income, and residential address. It asks the account holder to declare the source of wealth for funds in their NETELLER account is from salary/self-employed income, assets/investing/trading, or other. It also requires the account holder confirm the information is accurate and select supporting documents to evidence the source and volume of funds, such as pay slips, bank statements, investment certificates, or other documentation. The completed form must be e-signed and returned.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    936 views2 pages

    Source of Wealth - NETELLER

    Uploaded by

    Tahsin Ove
    This document is a source of wealth declaration form for a NETELLER account. It requests the account holder provide their name, nationality, occupation, annual income, and residential address. It asks the account holder to declare the source of wealth for funds in their NETELLER account is from salary/self-employed income, assets/investing/trading, or other. It also requires the account holder confirm the information is accurate and select supporting documents to evidence the source and volume of funds, such as pay slips, bank statements, investment certificates, or other documentation. The completed form must be e-signed and returned.

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    © All Rights Reserved
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    Source of Wealth Declaration

    ‘Source of Wealth describes the way (or ways) in which you accumulated the money being used to fund
    your NETELLER account’. Paysafe Financial Services Limited, as an authorised Electronic Money
    Issuer in the United Kingdom, is obligated to collect the following information:

    Please complete the following form

    I,___________________________________________ ___________________________________
    NAME NATIONALITY

    ________________________________________ , ______________________________________
    OCCUPATION/PROFESSION/JOB TITLE ANNUAL INCOME

    of_________________________________________________________________________________
    RESIDENTIAL ADDRESS

    Hereby:

    1. Declare the source of wealth for funds used in my NETELLER Account(s) is:

    Salary / Self Employed income

    Assets/Investing/Trading

    Other (Please indicate) _____________________________________________________

    2. Declare and represent that the funds uploaded to my NETELLER Account have been acquired
    legitimately

    3. Confirm that the information in the present Declaration is true and accurate

    Please see over page and complete form as per the instructions
    4. Please select and attach supporting documents listed below which correspond with your
    chosen source of wealth and evidence the volume of funds you have uploaded to your
    NETELLER account:

    Salary / Self Employed Income


    last 3 months payslips
    letter from employer on company letterhead (including details of income)
    3 months of bank statements showing salary payments
    contract / agreement for self-employed services
    copies of invoices forself-employed services

    AND/OR

    Assets / Investing / Trading

    company bank statement


    certified investment certificate contract notes
    certified copy of contract of sale
    certified copy of latest audited company accounts
    profit and loss trading portfolio

    AND/OR

    Other clear evidence that would support "affordability" in relation


    to your transacting levels with us.

    Please provide documentary evidence of your listed source of wealth, for the funds used in
    your NETELLER account, after we review your documentation we will either advise you that
    the verification is complete or we will contact you if further information is required.

    ________________________________________ ________________________________________
    DATE E-SIGNATURE

    Please E-Sign and reply directly to the email you received.

    Please be advised if you prefer to print, sign and scan of the document this is acceptable.

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