INCLUDING ADDRESS
PHONE & EMAIL ADDRESS
INVESTOR TRANSACTION CODE:
DOCUMENTATION ENCLOSED
I, Investors Name Here, have read and accepted the above as of this date: 21 April 2019
Personal Information
First Name :
Middle Name :
Last Name :
Gender :
Date of Birth :
Country of Citizenship :
Passport Number :
Date of Issue :
Date of Expiry :
Country of Issuance :
Home Street Address :
Telephone Number : +
Mobile/Cell Phone Number : +
Facsimile Number :
E-Mail Address :
Languages / Translator
Languages :
Do you speak English? :
If No, Name of Translator :
Telephone Number :
Email Address :
Corporate Information
Full Name of Corporation :
Street Address :
City :
State :
Country :
Postal Code :
Telephone Number :
Fax Number :
Mobile Number :
Email Address :
Legal Advisor
Full Name :
Company :
Address :
City :
State :
Country :
Postal Code :
Telephone Number :
Fax Number :
Email Address :
Bank Information
*Please attach copy of Account Statement from Bank*
Cash Amount :
CD Number, if applicable :
Bank Name :
Street Address :
City :
Country :
Account Name :
Account Number :
Authorized Account Signatory:
Bank Officer # 1 Name :
Bank Officer # 2 Name :
Telephone Number :+
Fax Number :+
SWIFT Code :
Bank Officer Name :
Telephone Number :
Fax Number :
Investment
I, Investors Name Here, hereby swear under penalty of perjury, that the information provided
herein is accurate and true as of this date: 21 April 2019
PASSPORT
Know all men, by these that I, Investors Name Here, at the address shown above, give you clear
notice that you have my direct permission and full authority to do all matters necessary to
confirm, verify, and authenticate my beneficially owned cash funds and/or application asset(s)
and its associated good standing account status, in an amount of AMOUNT IN WORDS United
States Dollars (1,000,000.00 USD) on a bank to bank basis. The below stated beneficially owned
account is of good, clean, and cleared cash funds obtained via legal means, and is currently
available at the bank coordinates below:
Cash Amount :
Bank Name :
Street Address :
City :
Country :
Account Name :
Account Number :
Authorized Account Signatory:
Bank Officer # 1 Name :
Bank Officer # 2 Name :
Telephone Number :+
Fax Number :+
In witness hereof I, Investors Name Here, hereby swear under penalty of perjury, that the
information provided herein is accurate and true as of this date: 21 April 2019
PROOF OF FUNDS
Dear Sir,
I, NAME, bearing COUNTRY Passport No. NUMBER, hereby authorize Michael B., bearing USA
Passport No. 549001773 having the below contact details, to act as my private asset manager
and official liaison in such matters to carry out the duty and responsibility as primary contact to
coordinate communication, receive and review, negotiate, and prepare agreements, provide my
CIS/KYC and confidential information, and any other matter that might facilitate our mutual
transaction.
I, NAME, hereby swear under penalty of perjury that the information provided herein is accurate
and true as of this date: April 21, 2019
Michael B. Passport
PASSPORT