Cis Trust Corporate 1

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[INSERT APPLICANT LETTERHEAD IN HEADER SPACE]

CLIENT INFORMATION SHEET

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

Full Name of Corporation:


Date of Incorporation:
Incorporated in (City/State/Country):
Registration Number:
Board of Directors (Name & Title):
Officers (Name & Title):
Shareholders (List all shareholders owning more than 5 % of all outstanding shares of Corpora-
tion):

Location of Address: Registered Address (Corporation)

Full Name of Corporation:


Street Address:
City:
State:
Country:
Postal Code:

Location of Address: Mailing Address (Corporation)

Full Name of Corporation:


Street Address:
City:
State:
Country:
Postal Code:

Contact Information (Corporation)

Telephone Number:
Fax Number:
Mobile Number:
Email Address:
Skype Name:

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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:

Bank Information (Corporate)


* Please attach copy of account statement from bank

Bank Name (where funds are currently on deposit):


Street Address:
City:
State:
Country:
Postal Code:

Account Name:
Account Number:
Sort Code ABA No.:
SWIFT Code:
Account Signatory (1):
Account Signatory (2):

Bank Officer # 1 Name:


Bank Officer # 2 Name:
Telephone Number:

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Fax Number:

Personal Information of Officer(s) of Corporation / Passport Information


(Please attach copy of corporate resolutions adopted by the Board of Directors appointing and
authorizing said officer(s) to represent and legally bind the corporation)
* Duplicate the section below for each Director.

First Name:
Middle Name:
Last Name:
Gender:
Date of Birth:
Social Security Number:
Country of Citizenship:
Languages:

Passport Information of Officers(s) of Corporation


*Please attach copy of photo and signature page of passport

Passport Number:
Date of Issue:
Date of Expiry:
Issuing Authority:

Location of Address: Home-Legal Residence (Officer(s) of Corporation)


(Please attach copy of utility bill)

Full Name of Officer:


Street Address:
City:
State:
Country:
Postal Code:

(Below, duplicate the section above for each Director)

Investment

Funds available for this transaction:

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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

For and on behalf of (NAME OF COMPANY)

Signature: __________________________________ SEAL OF COMPANY


Name / Title:
Company:
Passport Number:
Date of Issue:
Date of Expiry:
Country of Issuance:

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CORPORATE REGISTRATION

PASSPORT

APPLICANT INITIALS ___________ PAGE 5 OF 7


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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

APPLICANT INITIALS ___________ PAGE 6 OF 7


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Less than 3 months old (i.e. electricity bill, gas bill, or similar), of the benefi-
cial owners and directors of the company.

APPLICANT INITIALS ___________ PAGE 7 OF 7

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