Compliance Certificate Of Incorporation
Company Info
Company Name *
Email *
Phone *
Trade Name *
Address 1
Address 2
Zip Code *
Country *
AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua & BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia & HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCongo Democratic RepublicCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEast TimorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalThe NetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPalestinian State*PanamaPapua New GuineaParaguayPeruThe PhilippinesPolandPortugalQatarRomaniaRussiaRwandaSt. Kitts & NevisSt. LuciaSt. Vincent & The GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican City (Holy See)VenezuelaVietnamYemenZambiaZimbabwe
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 *
SelectPhysical PersonCompany
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 *
Details of Director2 *
Details of Other Director *
Shareholders
Controlling Shareholder *
Major Shareholder *
Other Shareholder *
Share Percentage
Major Shareholder*
Declaration of Source and Origin of Resources of the transaction
Products and Services *
SelectInternational Bank TransferNational Bank Transfer
Source of Transfer of Funds *
SelectAutomatic ReinsuranceFacultative Reinsurance
Origin of Funds *
SelectAll Activity Carried Out AbroadMain Activity Carried Out Within the CountryMix of Activity in the Country and Abroad
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. *
SelectYesNo
If Yes, Please Explain :
Financial Information
Annual Income from Main Activity *
SelectLess than $250,000$250,000 to $1 Million$1 Million to $10 MillionMore than $10 Million
Annual Income from Other Activity *
Required Documents
Licence or Registration Certificate *
Choose file
Upload
only pdf, jpg, png format acceptable
Certificate of Incumbency
Authorised Signatory or Legal Representative Document *
Copy of ID Card or Passport of the Directors *
Audited Financial Statement of the Last Period *
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.
