Client Information Form

Proposed / Incorporated by

Company Name:

Jurisdiction

Company registration no. (if incorporation service is not rendered by us):

Certificate of Incorporation and Other Incorporation Documents

SECTION A: SHAREHOLDER(S) AND DIRECTOR(S)

Surname:

Other Name:

Capacity:

Director Shareholder Significant Controller

Hong Kong ID:

Passport:

Geographic Phone Number

Mobile Phone Number

Primary Contact Email Address

Secondary Contact Email Address

Occupation

SECTION C: SOURCE OF FUND

Source Of Fund:

Ultimate Beneficial Owner(s) / Shareholder(s)
Loan from related party
Retained Earnings / Return on Investment
Others (please specify):

SECTION E: CLIENT DECLARATION

I / We confirm that:

The Company is ultimately beneficially owned / significantly controlled by the individual(s) and/or legal entity(ies) listed in Section A above.
Neither I / we, nor any company that I / we have been involved in the directorship or management of, have ever been the subject of a regulatory judicial investigation.
I / We have never been disqualified from acting as director(s) of a company in any jurisdiction.
The Company's funds do not arise from, nor will be used for, criminal or any other illegal activities.
All information provided in the above Client Information Form is true and correct.
I/We have declared that the information given above is true and accurate in each and every respect.

Signature:

Signer Name:

Attachment Instructions :

Select Attachment

Review

Company Name :

Jurisdiction :

Company registration no.

Surname :

Other Name :

Capacity :

Hong Kong ID :

Passport :

Passport Country :

Geographic Phone Number :

Mobile Phone Number :

Primary Contact Email Address :

Secondary Contact Email Address :

Occupation :

Source Of Fund :

Source Of Fund (other) :

Signature :

Attachment: