Section ANature of AssignmentAuditAccountsConsultancyCorporateTaxH.RLegalSection BDetailsCompanyEstablishmentOthersHow was the customer introduced ?Referred by (Name)Type of Customer ?ExistingNewLegal Name (As per Trade License)Complete Physical Address :Complete Registered Address: (If different from above)PhoneMobileEmail AddressWebsiteDate of IncorporationPlace of IncorporationType of Legal entity ?LLCFZEFZCJurisdiction of the CompanyCorporate Registration / Trade License NumberDate of Expiry of Corporate Registration / Trade LicenseVAT Registration Number (if any) Please mention if not registeredBrief description of the company’s business activities:Section CDetails (Cont..)If a Holding Company, name of any other subsidiaries / branches / associated companiesIf not, Group Company (if any)Section DSource of Wealth (Applicable for UBOs)InheritanceInvestmentsEmployment IncomeBusiness Ownership InterestsSource of Funds (Bank Details & Bank jurisdiction)Client’s approximate Net WorthUp to AED 1 MillionUp to AED 2 MillionUp to AED 5 MillionUp to AED 20 MillionOtherEstimated Annual Income (AED)Section EListed EntityPlease provide name of Stock Exchange and TIN numberSection FSignatory Details - Please list the names of all Board Members, directors or equivalent persons with executive authority.NamePositionCountry of ResidencePassport No.Date of BirthPassport Expiry DateNamePositionCountry of ResidencePassport No.Date of BirthPassport Expiry DateNamePositionCountry of ResidencePassport No.Date of BirthPassport Expiry DateSection GShareholders / Partners - Please list the names of all shareholders / partners details.Name% of Shares heldCountry of ResidencePassport No.Date of BirthPassport Expiry DateName% of Shares heldCountry of ResidencePassport No.Date of BirthPassport Expiry DateName% of Shares heldCountry of ResidencePassport No.Date of BirthPassport Expiry DateSection HUBO - Please list the names of all Ultimate Beneficial Owners.Name% of Shares heldCountry of ResidencePassport No.Date of BirthPassport Expiry DateName% of Shares heldCountry of ResidencePassport No.Date of BirthPassport Expiry DateName% of Shares heldCountry of ResidencePassport No.Date of BirthPassport Expiry DateSection IPEP - Politically Exposed Person Details.Position HeldOrganizationFromToPosition HeldOrganizationFromToPosition HeldOrganizationFromToSection JDocument ChecklistCertified copy of Certificate of IncorporationChoose FileNo file chosenDelete uploaded fileCommercial / Trade LicenseChoose FileNo file chosenDelete uploaded fileCertified copy of valid passport with visa page of Directors and Authorized signatoriesChoose FileNo file chosenDelete uploaded fileCertified Copy of valid passport with visa page for all UBOsChoose FileNo file chosenDelete uploaded fileVAT Registration CertificateChoose FileNo file chosenDelete uploaded fileSupporting document for Source of WealthChoose FileNo file chosenDelete uploaded fileCertified Copy of Trust DeedChoose FileNo file chosenDelete uploaded fileCertified Copy of Bearer Share registerChoose FileNo file chosenDelete uploaded fileCertified Copy of POA or Board resolution providing power to the Authorized SignatoryChoose FileNo file chosenDelete uploaded fileCopies of supporting documents listed above should be certified.Who can Certify the documents: • Registered lawyer • Government or ministry official • Registered Notary • Chartered Accountant • Person working in Embassy or Consulate.Section KMeeting with ClientIs the client available for face-to-face meeting?YesNoSection LGeographical JurisdictionsIf business activities are conducted in more than one country, please list name of all countries or alternatively top five country in comparison of total revenue earned / invoiced.Is the company involved in business with any of this country - Iran, North Korea, Somalia, Sudan and Libya and / or listed into sanction list by the UAE competent authority as on signatories KYC form declaration.Does the company receive and / or make payment in cash in excess of AED 55,000?YesNoSubmit