KYC FORM FOR INDIVIDUAL | FINANCIAL SERVICES

In Luxembourg, the Know Your Customer (KYC) requirements for accountants are guided by strict anti-money laundering (AML) and Counter-terrorism financing (CTF) regulations.

Here's the minimum list of the documents we request to proceed to the KYC process before to start a business relationship.

Max 10 minutes - Scan needed

Main information

First name as in the ID*

First name as in your official documents

e.g. Daniel, not "Dan"

Last Name as in the ID*

Last name as in your official documents

e.g. Steinmetz, not "Stein"

Other name as in the ID

Title*

Civil status*

Birth Date*

Birth Date

Birth country*

Nationalities*

Birth place*

Address number*

Address street*

Postal code*

Addres city*

Addres country*

Profession*

Fiscal residence*

Fiscal number - TIN*

Valid Email address for confirmation process*

Valid Phone number for confirmation process*

I declare on my honour that the data contained in this declaration are sincere and correct and undertake to mention any changes as soon as possible.

IDENTITY DOCUMENTS AND PROOF OF ADDRESS

Requirements:Passport and National ID: Clear and in good quality, color copies of the front page and of the back page showing personal information. Signed and dated from the date of the demand.

Ensure the document is valid (check the expiration date).Place the ID flat on a surface to avoid glare and shadows.The document must clearly show:Full name.Date and place of birth.Document number.Expiry date.For all natural persons residing outside the EUR, mandatory to certified your documents with a legal authority in your country included Date of certification of less than 6 months.

Passport or National ID card back and side page in good quality*

Proof of Address (Mandatory):Accepted Documents: Certificate of residency from myguichet.lu, utility bill, bank statement, government correspondence.Requirements:Dated within the last 3 months.Must show the client's full name and current address.If providing a digital copy, ensure it is legible and not cropped.Tips for Clients:Utility bill: Preferably electricity, water, or internet (avoid mobile bills unless no other option).Bank statement: Ensure account numbers are partially redacted for privacy.Use high-resolution scans or photographs.

Proof of address (Certificate of residency or Utility bill from less than 6 months)*

GDPR Compliance and Consent:

I consent to the collection, processing, and storage of my personal data in accordance with the General Data Protection Regulation (GDPR) and the privacy policy of Financial Services. I understand that my data will only be used for compliance and regulatory purposes.

SOURCE OF FUNDS

Representations

The undersigned beneficial owner hereby:

-declares that he/she is acting in his/her own name and on his/her own behalf;

-declares that he/she does not exercise nor has he/she ever exercised personally a “Prominent Public Function” and has no connection with a person exercising or having exercised a “Prominent Public Function” and is not considered as a “Politically Exposed Person”;

-declares that the transaction he/she wishes to commence and carry out is accomplished in his/her sole interest and that he/she is not an intermediary for any third party;

-declares that all funds remitted or to be remitted in relation with the abovementioned transaction or any of the accounts of the beneficial owner or companies of the beneficial owner do not and will not originate, neither do or will they be destined to fund illegal or criminal activities, especially drug money laundering, but on the contrary do or will originate from one or more of the following sources (please tick the appropriate box(es));

Select the origin of the funds

Other (Please detail):

Documents which justify the source of the funds

-declares that his/her own funds do not derive from a criminal activity or a terrorist activity, including but not limited to the offences referred to in article 506-1 of the Luxembourg Criminal Code or tax crimes relating to direct and indirect taxes

(i) which fall within the category of serious offences as defined in the national law of each of the countries involved or

(ii) which are punishable by deprivation of liberty or a detention order for a maximum of more than one year or

(iii) as regards such countries that have a minimum threshold for offences in their legal system, all offences punishable by deprivation of liberty or a detention order for a minimum of more than six months

-undertakes to inform the accounting firm FINANCIAL SERVICES AMAS REPORT SARL-S, having its offices at 142 boulevard de la Pétrusse, L-2330 Luxembourg, Grand Duchy of Luxembourg (the “Accounting Firm”), without delay of any changes to any of the information listed above; and

-declares that the Accounting Firm informed him/her of the consequences of a false or fraudulent declaration.

Declaration of Honor

I, the undersigned and hereby declare on my honor that the information and data provided in this declaration are truthful, accurate, and up to date to the best of my knowledge and belief.

I acknowledge and confirm the following:

1. Accuracy of Information: o I undertake full responsibility for the accuracy and authenticity of the documents and information submitted as part of this Know Your Customer (KYC) process. o I commit to notifying [Your Company Name] of any changes to the data provided without undue delay, including but not limited to changes in personal information, financial circumstances, or legal status.
2. Regulatory Compliance: o I understand that this declaration is made in accordance with the obligations outlined under Luxembourg's anti-money laundering (AML) and counter-terrorism financing (CTF) legislation, as well as the applicable provisions of European Union directives, including Directive (EU) 2015/849 (Fourth AML Directive) and its subsequent amendments.
3. Data Protection and GDPR Compliance: o I acknowledge that the personal data provided will be processed in compliance with the General Data Protection Regulation (GDPR) (Regulation (EU) 2016/679) and any relevant national data protection laws. o I consent to the collection, processing, and storage of my personal data solely for the purposes of fulfilling KYC requirements, ensuring regulatory compliance, and maintaining a lawful business relationship. o I am aware of my rights under GDPR, including the right to access, rectify, or erase my personal data, as well as the right to lodge a complaint with a supervisory authority if I believe my data has been misused.
4. Legal Consequences of False Declarations: o I understand that providing false, misleading, or incomplete information may result in the termination of the business relationship, legal penalties, and reporting to the relevant regulatory authorities, as required by law.

This declaration is made freely, without coercion, and with a full understanding of its legal implications.

Dated on:

At the location:

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