Compliance Certificate Of Incorporation
Personal Information
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Last Name *
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Date of Birth *
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Spouce Partner Information
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Spouce / Partner Info
If you are /related to/ or have been politically Exposed Person, write the details here
Financial Information
Annual Income (Main Activity) *
SelectLess than $250,000$250,000 to $1 Million$1 Million to $10 MillionMore than $10 Million
Annual Income (Other Activities) * SelectLess than $250,000$250,000 to $1 Million$1 Million to $10 MillionMore than $10 Million
Declaration
"I declare that the information contained in this form is true, complete and proportionate. Reliable and up-to-date information on all aspects on which questions have been asked." The applicant declares that: has not been involved in, has not been convicted of or is under investigation anywhere in the world for offences related to the production, trafficking, consumption of drugs or any other offence associated with drugs; or money laundering. I (We) confirm that I (We) have and verify the due diligence evidence 01 011 beneficial owners, attorneys, beneficiaries, directors, officers and signatories of the services necessary for W-safe Reinsurance Limited; and agree to provide such information and/or documentation requested by W-safe Limited. I (We) declare under penalty of perjury that this statement has been examined and is true, correct and complete to the best of knowledge and belief.
