kyc questionnaire
KYC QUESTIONNAIRE SegPay is gathering the following legally required information on the basis of its measures against money laundering and terrorist financing on its Customers. Company Registration Number
Company name Address
Postcode
Place
/ E-mail address
Telephone / Mobile
Country
Tax residency
VAT/TIN Registration Number
What is the nature/purpose of customer's activities, and have they changed in the last 12 months? Which is the company's retail bank?
What is the purpose of use of SegPay´s services?
Who are the Ultimate Beneficial Owners (UBO)* that own or control 25% shareholding or more? No Are there UBO´s Yes (add lines below if applicable) Date of birth
Name
Address
Share %
*Ultimate beneficial owner (UBO) in respect of a company means the natural person(s) who directly or indirectly ultimately owns or controls the corporate entity. Does a US person own or control, directly or indirectly, 25% shares or more, or has 25% or more voting rights the company?
Yes
No
Board members /Directors of the legal entity (add lines as applicable) Date of birth
Name and Address
How many board members (directors of the board) are required to bind the legal entity? Information on all persons who have unlimited authority to dispose of the company‘s assets. Date of birth
Name and Address
Who holds the power of attorney for the company? (add lines as applicable) Date of birth
Name and Address
Other explanations on ownership, control, board members or power of attorney (if applicable)
Mandatory enclosures Certificate from a public register, as applicable, e.g. Register of Limited Companies (not older than three months) Verified copy of rules which govern use of powers of attorney or Original copy of power attorney (if applicable) Verified copies of ID's for board members, holders of powers of attorney and other parties authorized to bind the legal entity Organizational chart showing the Ownership structure, including intermediates leading up to the UBO(s), clearly indicating the share percentage of each Verified copy of bank account in the name of the customer used in relation to the account at Segpay (copy of bank statement) SegPay reserves the rights to request for additional documents or information as required. The undersigned client confirms that the mentioned information is correct and true and grants SegPay rights to gather information about the client, it´s owners, management, board of directors and beneficial owners from a third party, including financial information, such as credit rating and defaults. The client also undertakes to inform SegPay in writing without delay, if any of the above mentioned information change that is relevant to SegPay. _ ___________________________________ Place and date
____________________________________________ Signature of the client
Company name Address
Postcode
Place
/ E-mail address
Telephone / Mobile
Country
Tax residency
VAT/TIN Registration Number
What is the nature/purpose of customer's activities, and have they changed in the last 12 months? Which is the company's retail bank?
What is the purpose of use of SegPay´s services?
Who are the Ultimate Beneficial Owners (UBO)* that own or control 25% shareholding or more? No Are there UBO´s Yes (add lines below if applicable) Date of birth
Name
Address
Share %
*Ultimate beneficial owner (UBO) in respect of a company means the natural person(s) who directly or indirectly ultimately owns or controls the corporate entity. Does a US person own or control, directly or indirectly, 25% shares or more, or has 25% or more voting rights the company?
Yes
No
Board members /Directors of the legal entity (add lines as applicable) Date of birth
Name and Address
How many board members (directors of the board) are required to bind the legal entity? Information on all persons who have unlimited authority to dispose of the company‘s assets. Date of birth
Name and Address
Who holds the power of attorney for the company? (add lines as applicable) Date of birth
Name and Address
Other explanations on ownership, control, board members or power of attorney (if applicable)
Mandatory enclosures Certificate from a public register, as applicable, e.g. Register of Limited Companies (not older than three months) Verified copy of rules which govern use of powers of attorney or Original copy of power attorney (if applicable) Verified copies of ID's for board members, holders of powers of attorney and other parties authorized to bind the legal entity Organizational chart showing the Ownership structure, including intermediates leading up to the UBO(s), clearly indicating the share percentage of each Verified copy of bank account in the name of the customer used in relation to the account at Segpay (copy of bank statement) SegPay reserves the rights to request for additional documents or information as required. The undersigned client confirms that the mentioned information is correct and true and grants SegPay rights to gather information about the client, it´s owners, management, board of directors and beneficial owners from a third party, including financial information, such as credit rating and defaults. The client also undertakes to inform SegPay in writing without delay, if any of the above mentioned information change that is relevant to SegPay. _ ___________________________________ Place and date
____________________________________________ Signature of the client
