Client KYC

Compliance
Certificate Of Incorporation

Client KYC

DUE DILIGENCE

Company Info

Company Name *

Email *

Phone *

Trade Name *

Address 1

Address 2

Zip Code *

Country *

City

State

Country of Domicile

Country of Constitution

Years of Constitution

Type of Legal Structure

Registered Number

Main Company Activity

Website

Name of Contact in W-safe

BOD

Director 1 *

Director 2 *

Other Director *

Name

I.D Card/Passport Number

Date of Birth (DD/MM/YYYY)

Nationality

Residence (Country)

Profession

Politically Exposed Person (PEP) Details

Details of Director1 *

Name

I.D Card/Passport Number

Date of Birth (DD/MM/YYYY)

Nationality

Residence (Country)

Profession

Politically Exposed Person (PEP) Details

Details of Director2 *

Name

I.D Card/Passport Number

Date of Birth (DD/MM/YYYY)

Nationality

Residence (Country)

Profession

Politically Exposed Person (PEP) Details

Details of Other Director *

Shareholders

Controlling Shareholder *

Major Shareholder *

Other Shareholder *

Name

Share Percentage

I.D Card/Passport Number

Date of Birth (DD/MM/YYYY)

Nationality

Residence (Country)

Profession

Politically Exposed Person (PEP) Details

Controlling Shareholder *

Name

Share Percentage

I.D Card/Passport Number

Date of Birth (DD/MM/YYYY)

Nationality

Residence (Country)

Profession

Politically Exposed Person (PEP) Details

Major Shareholder*

Name

Share Percentage

I.D Card/Passport Number

Date of Birth (DD/MM/YYYY)

Nationality

Residence (Country)

Profession

Politically Exposed Person (PEP) Details

Other Shareholder *

Declaration of Source and Origin of Resources of the transaction

Products and Services *

Source of Transfer of Funds *

Origin of Funds *

Indicate Whether the Legal Representative, Proxy or the Company itself are or have been the subject of investigation, enquiry or conviction for unlawful activities, or money laundering or terrorist financing crimes. *

If Yes, Please Explain :

Financial Information

Annual Income from Main Activity *

Annual Income from Other Activity *

Required Documents

Licence or Registration Certificate *

Choose file

only pdf, jpg, png format acceptable

Certificate of Incumbency

Choose file

only pdf, jpg, png format acceptable

Authorised Signatory or Legal Representative Document *

Choose file

only pdf, jpg, png format acceptable

Copy of ID Card or Passport of the Directors *

Choose file

only pdf, jpg, png format acceptable

Audited Financial Statement of the Last Period *

Choose file

only pdf, jpg, png format acceptable

Statement

"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.