Know Your Client Procedure Form | Advanced Quality Gemstones

Know Your Client Procedure - Customer's declaration

In accordance with the articles 2-9 of the Prohibition of Money Laundering Order (Identification, Reporting and Record-Keeping requirements of dealers in precious stones to prevent money laundering and the financing of terrorism) 5774-2014, you are requested to fill in the following particulars:

Customer Identification

Information about the client

Full Name

ID Number

Physical Address

Postal Address

Phone Number

Fax

Contact Person Name

Date of Birth

Place of Birth

Nature of Business

Number of years in business

Public figure

Yes No

Purpose of Purchase

Connection to Israel

Bank details

Name of Bank

Branch Address

Verification of the Identity

Face to face identification:

I hereby to confirm that on the day

appeared before me the abovementioned customer whose name is

with passport number

which is attached to this document.

Not face to face identification:

I hereby to confirm that on the day

I identified the abovementioned customer with documents whose name is

with passport number

the copy which is attached to this document.

Name of the person performing the identification

ID Number

Date

Signature

Know Your Client Procedure - Customer's declaration

Customer Identification

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