NOMBRE COMPLETO
Passport No: XXXXXX of Colombia
Address: XXXXXXXXX CIUDAD, DEPARTAMENTO O ESTADO - PAIS
Telephone Mobile: (+57) XXXXXXX
E-mail:
[email protected] CLIENT INFORMATION SHEET
In accordance with Articles Two (2) through Five (5) of the Due Diligence Convention and the Federal Banking Commission
Circular of December 1998, concerning the prevention of money laundering, and Article 305 of the Swiss Criminal Code, the
following information may be supplied to banks and/or other financial institutions for the purpose of verification of identity and
activities of the investing Member, and the nature and origin of the funds which are to be utilized. All parties have an obligation
to respect professional secrecy and to take all appropriate precautions to protect the confidentiality of the information each
holds in respect of the other's activities. This legal obligation shall remain in full force and effect at ALL times.
Directions: This document should be completed in full. If a line item does not pertain then insert the term:
“N/A”
First Name : XXXXXXXX
Middle Name : N/A
Last Name : XXXXXXXX
Gender : XXXXXXXX
Date of Birth : MES XX – 19XX
Social Security Number : N/A
Country of Citizenship :xxxxxxxxxx
Languages : SPANISH
Tel : (xxxx) XXXXXXXX
E-mail : [email protected]
Passport Information of Officers(s) of Corporation
*Please attach copy of photo and signature page of passport
Passport Number : XXXXXXXXX
Date of Issue : XX MES 20XX
Date of Expiry : XX MES 20XX
Issuing Authority : XXXXXXXXXX
Location of Address: Home-Legal Residence
Full Name of Officer :XXXXXXXXXXXX
Street Address :XXXXXXXXX
City : XXXXXXXXX
State : XXXXXXXXXXX
Country : xxxxxxxxx
Postal Code : N/A
(You may duplicate the section above for each Director involved in transaction)
1. I, «NOMBRE COMPLETO», hereby declare as the undersigned, having the full signatory power to transfer,
assign, pledge or reserve upon terms satisfactory to me, with full authority to execute all documents and
agreements relating to the same.
2. I, «NOMBRE COMPLETO», hereby grant permission to contact all parties and institutions named within
this document, including the authorization to verify these disclosures.
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NOMBRE COMPLETO
Passport No: XXXXXX of Colombia
Address: XXXXXXXXX CIUDAD, DEPARTAMENTO O ESTADO - PAIS
Telephone Mobile: (+57) XXXXXXX
E-mail: [email protected]
3. I, «NOMBRE COMPLETO» , hereby swear under penalty of perjury, that the information provided herein
is accurate and true as of this date: 29 April 2025.
4. I, «NOMBRE COMPLETO» above is accurate and true as of 29 April 2025.
FIRMAR CON TINTA HÚMEDA AZUL HUELLA DIGITAL
Signature: __________________________________
Name / Title : XXXXXXXXXXXXXXX
Passport Number : XXXXXXXXXXXX
Date of Issue : XXXXXXXXXXX
Date of Expiry : XXXXXXXXX
Country of Issuance : XXXXXXXXXXX
PRIVATE AND CONFIDENTIAL INFORMATION
This communication may contain information that is legally privileged, confidential or exempt from disclosure. The information transmitted is intended only for
the person(s) or entity to which it is addressed. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon, this
information by persons or entities other than the intended recipient(s) is strictly prohibited. If you received this message in error, please contact the sender
and delete the materials from any computer. This electronic communication is covered by the Electronic Communications Privacy Act of 1986, Codified at 18
U.S.C. §§ 1367, 2510-2521, 2701-2710, 3121-3126. Also, see: http://www.ftc.gov/privacy/glbact/glbsub1.htm - Gramm-Leach-Bliley Act 15 USC, Subchapter I,
Sec. 6801-6809.
INFORMATION SELLER AND BUYER
ICC WARNING (ICC Commercial Crime Services.)
This is a very important message to anyone involved in the commodities industry on the new measures with respect to the Buyers and Sellers conducting old
and other commodities transactions. If an ICPO, LOI, RWA or BCL is issued and the documents are not real, the Buyer will be able to inform the FBI, ICC and
INTERPOL. In addition, after an FCO is sent to the Buyer, there should be a formal answer to the Seller from the Buyer. If there’s no response from the Buyer in
a timely manner, the buying company will be reported to the FBI, ICC and INTERPOL. If this action is repeated by the sellers, they will also be reported because
of abuse of the NCND, LOI, ICPO AND RWA OR BCL, FOR THIS IS A FEDERAL OFFENSE. It is important to transmit this to all clients that work with providers that
are members of the ICC, FBI and other international organizations, From this point forward, the international codes will be strictly enforced to exclude all
intruders that send out false information. Those who submit false NCND/IMFPA, LOI, ICPO, RWA OR BCL OR FCO, as well as FALSE PROOF OF PRODUCT (POP),
WILL BE CHARGED WITH A CRIME. This went into effect November 15, 2008 after a meeting was held between the Federal Reserve, European Central Bank,
Interpol, Federal Bureau of Investigation and Central Intelligence Agency.
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NOMBRE COMPLETO
Passport No: XXXXXX of Colombia
Address: XXXXXXXXX CIUDAD, DEPARTAMENTO O ESTADO - PAIS
Telephone Mobile: (+57) XXXXXXX
E-mail: [email protected]
COPY PASSPORT
PASAPORTE ESCANEADO
A COLOR CON ALTA DEFINICIÓN
CIS (Client Information Sheet)
Conocido como CIS, el Client Information Sheet es el documento que identifica al inversor con
todos sus datos.
Dicho documento será imprescindible para poder presentar la operación en la oficina del trader y así
iniciar un proceso de “Due Diligence”.
--------- THE END DOCUMENT ---------
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