Cis Trust Corporate 1
Cis Trust Corporate 1
Cis Trust Corporate 1
Directions: This document must be completed in full. If a line item does not pertain then insert
the term: “N/A” (non-applicable).
Corporate Information
Telephone Number:
Fax Number:
Mobile Number:
Email Address:
Skype Name:
Languages / Translator
Languages:
Does the Signatory speak English?:
If No, Name of Translator:
Tel Number:
Email Address:
Legal Advisor
Full Name:
Company:
Address:
City:
State:
Country:
Postal Code:
Telephone Number:
Fax Number:
Email Address:
Account Name:
Account Number:
Sort Code ABA No.:
SWIFT Code:
Account Signatory (1):
Account Signatory (2):
Fax Number:
First Name:
Middle Name:
Last Name:
Gender:
Date of Birth:
Social Security Number:
Country of Citizenship:
Languages:
Passport Number:
Date of Issue:
Date of Expiry:
Issuing Authority:
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 accu-
rate and true as of this date: September 15, 2022
CORPORATE REGISTRATION
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 ADDRESS
Less than 3 months old (i.e. electricity bill, gas bill, or similar), of the benefi-
cial owners and directors of the company.