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Verification of Identity Form
          CORPORATE (CLIENT) INFORMATION FORM          
(TO BE COMPLETED FOR EACH SHAREHOLDER/OFFICER/DIRECTOR)
(PURSUANT TO THE FINANCIAL & CORPORATE SERVICE PROVIDERS ACT.2002)
1.(a)Company Name:
2.(b)First Name: *
Last Name: *
(c)Name Of Business:
(d)Business Address:
(e)Telephone(Business):
Telephone(Home):
(f)Email: *
(g)Facsimile:
3.Nature Of Client's Business:
4.Recommended by:
Address:
Telephone:
Fax:
Email:
5.Name of Major Bank that you have dealt with for at least 3 years:
Address:
Telephone:
Fax:
Email:
Contact Person at Bank:
6.Name of Lawyer:
Address:
Telephone:
Fax:
Email:
7.Name of Accountant:
Address:
Telephone:
Fax:
Email:
8.Name of Referee(Personal):
Address:
Telephone:
Fax:
Email:
(FOR NOS 5-8- PLEASE PROVIDE WRITTEN REFERENCES FROM THE PERSONS NAMED)
9.Please Provide copies of the following:
(a.)Business Card (b.)Utility Bill(Showing your name and address)
(c.)CV(Resume) (d.)Passport/Drivers License
10.Contact person other than client:
Name:
Address:
Telephone:
Facsimile:
*Required