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PRIVADA

BANCA

PERSONAL INFORMATION
1) Name of investor
Present address
Place of birth
Passport number
Country of issue
2) Name of additional
investor
Place of Birth
Present address
Passport number
Country of issue

_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

3) Bank name
Address

_______________________________________________
_______________________________________________
_______________________________________________
Bank officer name
_______________________________________________
Telephone number
_______________________________________________

4) Beneficial owner
name
5) Beneficial owner
Signature
6) Personal attorney
Name
Address

_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

20 Rue Du Marche 5th etage

Geneva, Suisse

+41-435-000683 ext 837

BANCA
PRIVADA
7) Origin of wealth

_______________________________________________
_______________________________________________
_______________________________________________

8) Expected amount
of deposits first year _______________________________________________
9) Additional Documents required
A) Passport copy of all signatories
B) Bank reference of Beneficial owner
I hereby attest and confirm under oath that all of the above information is true and correct to the best of
my knowledge,
(name of person depositing )

_____________________
By:

20 Rue Du Marche 5th etage

Geneva, Suisse

+41-435-000683 ext 837

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