CLIENT INFORMATION SHEET – C.I.S.

Corporate Client’s
Full Name of Corporation:
Date of Incorporation:
Incorporated in (City/State/Country):
Registration Number:
Board of Directors (Name & Title):

Client’s Registered Office Information

Street Address:
City:
State:
Country:
Postal Code:
Telephone Number:
E-mail Address:

Legal Advisor:
Company Name:
Address:
Representative:
Telephone Number:
Email Address:

Contact Information of the Authorized Representative

Mobile Phone Number:
E-mail Address:

Client’s Bank Information (where funds will be paid)

Bank Name:
Address:
Country:
Account Name:
Account Number:
Sort Code ABA No.:
SWIFT Code:
Account Signatory (1):
Account Signatory (2):

Bank Officer # 1 Name:

Bank Officer # 2 Name:
Telephone Number:
For and on behalf of :___________________________________________

Signature: __________________________________
Name / Title:
Nationality:
Date and Place of Birth:
Passport Number:
Date of Issue:
Date of Expiry:
Country of Issuance:
Passport Data page (affix)