KNOW YOUR CUSTOMER FORM

(if filling in by hand, please use capital letters)

I. Personal information:

Recent MTCN (if applicable):

Full Legal Name (First, Middle,
MARTIN BORUS ANISET
Last/Family/Surname):
Primary Phone Number: +65 98859840
Secondary Phone Number:
Date of Birth (mm/dd/yyyy): 04/17/1985
Address (Street, number, city): BLK 855 JURONG WEST St 81 #08-522 SINGAPORE 640855

II. Please name your main senders:

Have
you met
What is your exact this
Senders name and What was the exact purpose
relationship with this person
approximate age of the transaction(s)?
Example: John M. Smith, 30
individual? face to
Example: Loan for car purchase
Example: Brother in law face?
Yes/No

JAMEELA SELVARAJ, 37 Choose

WIFE an item. Choose
MY an item.
PERSONNEL SAVING Choose
Yes

Choose an ACCOUNT
item. Choose an item.
MY PERSONEL SAVING
an item.
Choose
Yes
MARTIN BORUS ANISET 37 PERSONAL

Choose an item. Choose an item. an item.

Choose
Choose
an item.
Choose an item. Choose an item. Choose
an
an item.
Choose
Choose an item. Choose an item. item.
an item.
Choose
an
III. Please name your main receivers:
item.

Have
you met
What is your exact What was the exact purpose this
Receivers name and person
approximate age relationship with this of the transaction(s)? Example:
individual? Family support for living expenses, utility bills face to
Example: Anna Smith, 27
Example: Sister and scholarship face?
Yes/No

Choose an item. Choose an item. Choose

Choose an item. Choose an item. an item.
Choose
Choose an item. Choose an item. an item.
Choose
Choose an item. Choose an item. an item.
Choose
an item.
Choose an item. Choose an item. Choose
an item.
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 KNOW YOUR CUSTOMER FORM

IV. Please specify the month/months when you sent or received more money than usual and
please indicate the reason of higher transactional activity in that time period (if applicable):

Time period: Reason:

Example: March 2020 – more money received than Example: House renovation – purchase of
usual construction materials
Choose2022
MARCH an item. Choose an item. Choose
GOT BONUSan item.
FROM COMPANY
Choose an item. Choose an item. Choose an item.

V. Source of income.

In order to better understand how you are funding your transaction(s) (for sender only).

Primary Source: Secondary source (if applicable):

Example: Salary Example: Spouses salary and savings, additional income
from part time jobs

Choose
Salary an item. Choose
NO an item.

VI. Are you currently employed, or you have been employed in last 12 months?

✔ Yes,
☐ I’m currently employed or was employed in last 12 months
☐ No

If the answer is “Yes” please provide the information below:

Employer name:
Example: Western Union HALLIBURTON COMPLETIONS TOOLS SINGAPORE

Your current position:

Example: Accountant CNC MACHINIST

Your average monthly income after taxes:

Example: 1000 $ 5000- 7000

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 KNOW YOUR CUSTOMER FORM

VII. Business or Individual Details

Have you sent/received transactions on behalf of another person or on behalf of business?

(Examples: Yes, my neighbor asked me to send money on his behalf.
Yes, I’m receiving money on behalf of company)
☐
✔No.
☐ Yes, on behalf of another person.
☐ Yes, on behalf of business.

If the answer is “Yes”, please provide the information below:

Please indicate name,
surname, exact date of birth
of person involved in your
transactions:
For business please indicate
name of business and main
business activity:
Examples: Maria Lopez Smith 34,

Western Union, Money transfer

services

Explain why are you acting

on behalf of the business or
other individual:
Describe your relationship
with the business or other
individual:
Street Address:
City:
State/Province/County:
Postal Code/Zip Code:
Country:
Phone #:
Business Registration number:
Individual’s Occupation or
Business Type:
Example: Occupation of
individual:
Have you ever sent/received
money for purchasing of
goods or services? If yes,
please specify.
Western Union Privacy Statement (click here)