Kyc Individual Form
Kyc Individual Form
Kyc Individual Form
DOCUMENTATION ENCLOSED
None of the customary standards and practices that apply to normal, conventional business,
investing and finance applies to private funding programs. It is a "privilege" to be invited to
participate in a Blocked Fund Admin Hold Investment Program, not a "right." The trading
administrators and managers have a virtually endless supply of financially qualified applicants. All
things considered, the trading administrators and their banks will favor the applicant who provides
the best paperwork. An applicant should never underestimate what the trading entities knowledge
about him. Failure to provide full disclosure will disqualify the disingenuous. Clients must first
prove that they are qualified, not the other way around. Until the client is accepted by
Compliance, the Traders, and Trading Banks, no placement can occur. The U.S. Patriot Act has
introduced obligatory compliance procedures. Face‐to‐face interviews with compliance officers
and program management are occasionally required, but generally not necessary. Any arrogant or
demanding personality will guaranteed to be rejected. Only the principal owner of funds is
required as signatory. Corporations must empower an Officer or Director as sole, exclusive
signatory by using a Corporate Resolution. Not only do the funds have to be on deposit in an
acceptable bank; they must also be in an acceptable jurisdiction. It is felony fraud to submit
documents or financial instruments that are forged, altered or counterfeit. Such documents are
promptly referred to the appropriate law enforcement agencies for immediate criminal
prosecution. The practices, procedures and rules are determined by the U.S. Federal Regulatory
Authorities, Western European Central Banks program management, licensed traders and trading
banks. It is their decision whom to accept and whom to reject. Contract terms, yield, schedules,
etc., are made to fit their needs and schedules – and not the caprices or demands of the investors.
This marketplace is highly regulated and strictly confidential, and absolute confidentiality by the
investor is a key element of every contract. A client who breaks confidentiality will precipitate
instant cancellation. Finally, submission of the application documents to more than one
management group at a time is termed "shopping". If an investor "shops" he can expect that this
fact shall be quickly disseminated and known among the program management groups who
maintain close communication – and will then be accepted by none and rejected by all.
I, (NAME), have read and accepted the above as of this date: November 21, 2021
Signature: ________________________________
Name:
Passport Number:
Country of Issuance:
Dear Sir,
I, (NAME), the undersigned, on my own behalf, do hereby affirm that I have requested specific
information about Participation in Blocked Fund Admin Hold Investment Program. The
confidential information presented, received, and learned is not for the solicitation of funds,
nor is it an offering of any kind, but is for my general knowledge. I confirm that I have requested
the information of my own free will and choice, and further confirm that no party has solicited
me in any way. I hereby agree to keep all information received from you strictly confidential,
private, and proprietary, and that I will not disclose it to any other third party.
I, (NAME), further affirm that any funds or assets I decide to place are done so at my own
specific initiative, risk, and authorization with full consideration and without duress. I further
affirm that the information received is intended solely for my PRIVATE & CONFIDENTIAL USE
ONLY. I am a sophisticated investor by all definitions of that classification known to me; I make
my own investment decisions, and have legally acquired assets available. I, hereby reaffirm,
under penalty of perjury that I have requested information from you and your organization and
that you have not solicited me in any manner.
I, (NAME), understand that the contemplated transaction is strictly one of Investment Program
and is in no way relying upon existing regulations in relation to the United States Securities Act
of 1933 as amended, or related regulations, and does not involve the buy and sell of securities. I
further declare that I am not a licensed securities broker or government employee and
understand that neither are you or your organization. I mutually agree that this Private
Placement Transaction is exempt from the securities act.
I, (NAME), understand and agree that the ICC NON-DISCLOSURE and NON-CIRCUMVENTION
rules apply to this affidavit and business relationship, and hereby agree to the current
application standards of the International Chamber of Commerce, Paris, France which rules are
made a part hereof by this reference.
I, (NAME), under penalty of perjury, with full individual responsibility, hereby irrevocably,
confirm that neither myself, nor anyone else associated with my organization, my corporation,
or the individual investor are working for any Agencies of any Government. I further state
under penalty of perjury that I am not involved in any Government entrapment operation.
I, (NAME), under penalty of perjury, with full individual responsibility, hereby irrevocably,
confirm that neither myself, nor anyone else associated with my organization or corporation
have been convicted of a felony, either within the United States or anywhere in the world
where that crime would be considered equal to a US felony. To the best of my knowledge I am
not nor are any of my associates considered to be terrorists or on any watch list with the United
States Department of Homeland Security.
I, (NAME), agree that all email and facsimile transmitted documents shall be treated as original
documents. I further agree that in all cases where plural might apply where singular tense is
used it is so applied.
I, (NAME), hereby swear under penalty of perjury, that the information provided herein is
accurate and true as of this date: November 21, 2021
Signature: ________________________________
Name:
Passport Number:
Date of Issue:
Date of Expiry:
Country of Issuance:
Directions: This document must be completed in full. If a line item does not pertain then insert
the term: “N/A” (non-applicable).
Personal Information
First Name:
Middle Name:
Last Name:
Gender:
Date of Birth:
Social Security Number:
Country of Citizenship:
Passport Number:
Date of Issue:
Date of Expiry:
Issuing Authority:
Telephone Number:
Fax Number:
Mobile Number:
Email Address:
Languages / Translator
Languages:
Do you speak English?:
If No, Name of Translator:
Tel Number:
Email Address:
Corporate Information
Legal Advisor
Full Name:
Company:
Address:
City:
State:
Country:
Postal Code:
Telephone Number:
Fax Number:
Email Address:
Bank Information
* Please attach copy of account statement from bank
Account Name:
Account Number:
Sort Code ABA No.:
SWIFT Code:
Bank Name:
Street Address:
City:
State:
Country:
Postal Code:
Account Name:
Account Number:
Sort Code ABA No.:
SWIFT Code:
Investment
Type of currency:
Origin of funds:
Are these funds free and clear of all liens, encumbrances and third party interests:
I, (NAME), hereby swear under penalty of perjury, that the information provided herein is
accurate and true as of this date: November 21, 2021
Signature: ________________________________
Name:
Passport Number:
Date of Issue:
Date of Expiry:
Country of Issuance:
LETTER OF EXCLUSIVITY
Dear Sir,
I, (NAME), bearing (COUNTRY) Passport No. (NUMBER), authorized signatory of the Account No
(ACCOUNT NUMBER) at (NAME OF THE BANK), located at (ADDRESS OF BANK), the
undersigned, (hereinafter referred to as the “INVESTOR”), hereby with full, personal and legal
responsibility under penalty of perjury of law, represent, warrant and attest that:
I, the undersigned, have full legal title, rights, interest, control and authority to commit and
invest these funds and have chosen to do so of their own free will and sole decision without any
solicitation or influence from the trade administrators.
I, the undersigned, principal party involved in this transaction do not have any other party
working with or authorized to work with these funds allocated for above-mentioned reference
code, nor have any other parties been authorized to invest these funds, nor have other funds
from myself or the corporation been placed with other parties for a similar investment. Further
I attest that I have sent Cease & Desist Notices to any other intermediaries or trade groups that
have had access to our paperwork in the past.
I, the undersigned, herewith grant Program Manager, full exclusive right as our sole agent for 3
Months and 1 Day (Three Months and One Day) and/or the period of the contract whichever is
later including any proceeds of the investment if re-invested, from the above date, to enter
these funds for me, or the Corporation into the best available investment
I, the undersigned, understand, and I am fully aware that this transaction will be registered with
a major world bank and/or the Federal Reserve and the submitted private and confidential
paperwork will be forwarded for the sole purpose of establishing necessary dossier due
diligence and clearance for this transaction.
I, the undersigned understand and acknowledge that the Program Manger (hereinafter referred
to as the “Trade Coordinator”) will initially base the placement of this transaction on the face
value representations and documentation presented, and that any misrepresentation may be
considered criminal bank fraud. I, the undersigned hereby indemnify the Trade Coordinator
against any misrepresentations.
I, (NAME), hereby swear under penalty of perjury, that the information provided herein is
accurate and true as of this date: November 21, 2021
Signature: ________________________________
Name:
Passport Number:
Date of Issue:
Date of Expiry:
Country of Issuance:
LETTER OF INTENT
Dear Sir,
I, (NAME), the undersigned, hereby confirm under penalty of perjury, my full commitment and
agreement to participate in an investment opportunity, subject to my acceptance of the terms,
conditions and procedures that shall be outlined in the Proof of Fund Investment Program.
Furthermore, I hereby warrant and represent that I have available for placement into the
proposed investment, the sum of (SPELL AMOUNT) United States Dollars ($_____,000,000.00
USD) of clean, clear funds, free of any levy, liens or encumbrances and of non-criminal origin,
and herewith attach documentary evidence of same. I hereby warrant and represent that the
Rule of Full-disclosure has established these funds were legally obtained from non-criminal
business or actions. I further confirm that I am the beneficial owner of these cash funds, that I
have full signatory authority and control thereof, and that such funds are available for
immediate placement at my sole discretion.
I confirm and acknowledge, with full responsibility, that neither your company nor anyone
working on your behalf has solicited me; that the documents that I shall receive shall not be
deemed to be a solicitation of funds in connection with an investment program; and, that I am
approaching you voluntarily for the purpose of securing participation in a bonafide Secure
Blocked Fund Admin Hold Investment Program.
I am prepared to instruct my bank to act upon the funds as required pursuant to the specifics of
this program. In the case of Blocked Funds, it is my understanding the funds will be blocked
and or reserved) in the account and they will remain, at all times, non-callable.
I hereby request information from you covering the terms, condition and procedures of a
secured investment and look forward to commencing the transaction, upon my acceptance of
the agreement.
I, (NAME), hereby swear under penalty of perjury, that the information provided herein is
accurate and true as of this date: November 21, 2021
Signature: ________________________________
Name:
Passport Number:
Date of Issue:
Date of Expiry:
Country of Issuance:
Dear Sir,
I, (NAME), bearing (COUNTRY) Passport No. (NUMBER), duly authorized give notice to have
Cease and Desist and any/other group previous group approached in the past regarding our/my
files
I, (NAME), make a clear statement and confirm under risk and penalty of perjury not to have
any other entities, associations, financial institutions, affiliates, intermediaries, groups or others
with my /our permission nor any specific authorization to handle nor process any one of my
/our documents as from November 21, 2021
And that; All previous entities, associations, financial institutions, affiliates, intermediaries,
groups or others have been notified of such by the correspondent official Cease and Desist
Letter communication. This exclusive authority and engagement shall continue fully effective
until cancelled in writing by me.
I, (NAME), hereby swear under penalty of perjury, that the information provided herein is
accurate and true as of this date: November 21, 2021
Dear Sir,
I, (NAME), declare under penalty of perjury and with full personal and legal responsibility under
the International Court of Law that I legally hold the sum of (SPELL AMOUNT) United States
Dollars ($_____,000,000.00 USD) and it is deposited in Account No (ACCOUNT NUMBER) at
(NAME OF THE BANK), located at (ADDRESS OF BANK).
I further declare these funds are current and valid currency lawfully obtained and constitute
clean, cleared funds of legitimate, non-criminal, commercial origin. There are no liens,
contractual obligations or encumbrances of any kind against these funds.
I have full and complete, legal ownership of, and the unrestricted right and authority to pledge
or otherwise utilize these funds. The funds are ready for transfer or release upon my
instruction.
These funds are authentic and verifiable. I am not aware of any matter which could or might
cause the non-validation of these funds and I hereby indemnify the Program Manager and/or
assignees, intermediaries, or other parties involved, against any claims, demands, civil and/or
criminal in nature, and liabilities, damages, or expenses including without limitation any
attorney’s fees which may arise, whether in whole or in part, caused by reason of reliance upon
this sworn declaration.
I, (NAME), hereby swear under penalty of perjury, that the information provided herein is
accurate and true as of this date: November 21, 2021
Signature: ________________________________
Name:
Passport Number:
Date of Issue:
Date of Expiry:
Country of Issuance:
NOTARY:
Dear Sir,
I, (NAME), the undersigned, hereby confirm that I have requested of you and your organization
specific confidential information and documentation on behalf of ourselves. I hereby declare
that I am fully aware of the 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 funds of any sort, or any
type of offering, and is intended for our general knowledge only. I hereby affirm under penalty
of perjury that you have not solicited in any way. I understand that the contemplated
transaction is strictly one of private placement, and is in no way relying on or related to the
United States Securities Act of 1933, as amended or related regulations, and does not involve
the sale of securities. That affiant makes this affidavit knowing that the recipients will rely on
the contents hereof, and agrees to indemnify and hold-harmless all recipients and all other
parties -- including intermediaries -- against any and all claims resulting from any applicant
misrepresentation of a material fact or any loss of asset value or any act (legal or not) of a bank
or other financial institution, governing authority or agency, the Federal Reserve or an official or
other insider of any such entity. Further, I hereby declare we are not licensed brokers or
government employees, and understand that neither are you or your organization. We
mutually agree that this private placement transaction is exempt from the Securities Act, and
not intended for the general public, and all materials are for private use only.
Signature: ________________________________
Name:
Passport Number:
Date of Issue:
Date of Expiry:
Country of Issuance:
Know all men, by these that I, (NAME), at the address shown above, give you clear notice that
you have my direct permission and full authority to do all matters necessary to confirm, verify,
and authenticate my beneficially owned cash funds and/or application asset(s) and its
associated good standing account status, in an amount of (SPELL AMOUNT) United States
Dollars ($_____,000,000.00 USD) on a bank to bank basis. The below stated beneficially owned
account is of good, clean, and cleared cash funds obtained via legal means, and is currently
available at the bank coordinates below:
In witness hereof I, (NAME), hereby swear under penalty of perjury, that the information
provided herein is accurate and true as of this date: November 21, 2021
Signature: ________________________________
Name:
Passport Number:
Country of Issuance:
Dear Sir,
I, (NAME), hereby swear under penalty of perjury, that I AM THE SIGNATORY of the account,
that the funds belong to me, and the information provided herein is accurate and true as of this
date: November 21, 2021
Signature: ________________________________
Name:
Passport Number:
Date of Issue:
Date of Expiry:
Country of Issuance:
PASSPORT
PROVIDE COLOR COPY ENLARGED (140%) TO THIS SIZE (8½ X 11 INCHES). PICTURE MUST BE
CLEAR AND NOT DARK. ENLARGE & LIGHTEN (USING PHOTO SETTING). COLOR SCAN THE
PASSPORT INTO YOUR COMPUTER AT A HIGH RESOLUTION IN THE JPEG FORMAT AND INSERT.
PROOF OF FUNDS
CURRENT BANK STATEMENT OR RECENT THREE (3) DAYS TEAR SHEET IS THE REQUESTED
ACCEPTABLE PROOF OF FUNDS. BCL, BANK LETTERS SIGNED BY TWO (2) BANK OFFICER(S),
CERTIFICATE OF ACCOUNT OR CONFIRMATION OF FUNDS MAY BE INCLUDED AS
SUPPLEMENTAL BANKING. KINDLY INCLUDE UN‐SANITIZED CURRENT BANK STATEMENT OR
TEAR SHEET WITH YOUR SUBMISSION. IN THE CASE OF FINANCIAL INSTRUMENTS, TRANSMIT
HIGH-QUALITY, COLOR SCANS OF REAL DOCUMENTS FRONT AND BACK. THANK YOU.
Dear Sir,
I, (NAME), hereby swear under penalty of perjury that the information provided herein is
accurate and true as of this date: November 21, 2021
Signature: ________________________________
Name:
Passport Number:
Date of Issue:
Date of Expiry:
Country of Issuance: