Customer Registration Form Formato de Registro Persona Natural

Transcription

Customer Registration Form Formato de Registro Persona Natural
Customer Registration Form
Formato de Registro Persona Natural
General Info / Datos Generales
Last Name / Primer Apellido
Mother's Maiden Name / Segundo Apellido
First Name / Primer Nombre
Middle Name / Segundo Nombre
Date of Birth / Fecha de Nacimiento
Passport Number / Pasaporte
Contry of Birth / País de Nacimiento
Country of Residency / Pais de Residencia
Nacionality / Nacionalidad
Principal Activity / Actividad Principal
Secundary Activity / Actividad Secundaria
Gender / Sexo
Marital Status / Estado Civil
Home Status / Tipo de Vivienda (i.e. owned,rented) School Level / Nivel de Educación
Profession / Profesión
Source of Income / Fuentes de Ingreso
Address / Direccion
Home Address / Direccion de Hogar
Street Address / Calle o Avenida
Apt. Number / Casa o Apartamento
City / Ciudad and/ y County / Municipio
State/ Estado o Provincia
Country / Pais
ZIP Code / Zona Postal
Mailing Address / Direccion de Correspondencia
Street Address / Calle o Avenida
Apt. Number / Casa o Apartamento
City / Ciudad and/ y County / Municipio
State/ Estado o Provincia
Country / Pais
ZIP Code / Zona Postal
Page 1
Telephone / Telefonos
Home Phone / Telefono de Habitacion
Cell Phone / Telefono Celular
(+ Contry Code - Area Code - Phone Number)
(+ Contry Code - Area Code - Phone Number)
Office Phone / Telefono de Trabajo
Fax Number / Numero de Fax
(+ Contry Code - Area Code - Phone Number)
(+ Contry Code - Area Code - Phone Number)
e-Mail Address / Direccion de e-Mail
Home Address / Direccion Personal
Work Address / Direccion de Trabajo
Note: This e-mail address will be use for all comunications with the Bank, please make sure that you update this information
Nota: Esta direccion de e-mail sera utilizada para todas las comunicaciones que el Banco le envie, por favor mantengala
actualizada.
Products / Productos
Select all the Products to be activated / Seleccione los productos a ser activados
Advanced Checking Account
EZ Personal Savings
Bonus Savings
Accelerated Money Market
Euro Personal Account
CD Plus
Requisites / Requisitos
* Comply with minimum amount per product / Cumplir con el monto mínimo de apertura
* Account Opening Form / Formato de Apertura
* Source of Funds Declaration Form / Planilla de Procedencia de Fondos
* 2 Signature Cards / 2 Tarjetas de firmas
* An original Bank Reference indicating the average amount managed in the account and years
of activity / Una Referencia Bancaria en original, indicando antigüedad y los promedios
manejados en la cuenta
* Copy of valid ID and Passport from all authorized signatures /Copia del Documento de
Identidad y Pasaporte vigente y legible para todas las firmas autorizadas
* Proof of Residency (Utility Invoice) / Prueba de Residencia (Recibo de Servicio Publico)
Page 2
Authorized Signatures / Firmas Autorizadas
Number of Authorized Signatures
/ No. De Firmas Autorizadas :
Signatures Protocol / Protocolo de Firmas:
Joint / Conjuntas ____
Individual / Indistintas ____
Authorized Signature 1:
Fingerprint (Right Thumb)
Name:
Authorized Signature 2:
Fingerprint (Right Thumb)
Name:
Authorized Signature 3:
Fingerprint (Right Thumb)
Name:
Authorized Signature 4:
Fingerprint (Right Thumb)
Name:
AFFIDAVIT:
We hereby confirm that the information shown above confirms the identity of the Authorized Signatures. Furthermore, I will
inform Commonwealth Bank on a timely matter of any change concerning the information described above.
Confirmo que se ha cumplido, en todo lo posible, con la revisión de la identidad del/los arriba mencionado(s) firmante(s).
Además, me comprometo a informar a Commonwealth Bank sin demora sobre cualquier cambio concerniente con la
identidad de dicho(s) firmante(s).
Page 3
Authorized Signatures / Firmas Autorizadas
Number of Authorized Signatures
/ No. De Firmas Autorizadas :
Signatures Protocol / Protocolo de Firmas:
Joint / Conjuntas ____
Individual / Indistintas ____
Authorized Signature 1:
Fingerprint (Right Thumb)
Name:
Authorized Signature 2:
Fingerprint (Right Thumb)
Name:
Authorized Signature 3:
Fingerprint (Right Thumb)
Name:
Authorized Signature 4:
Fingerprint (Right Thumb)
Name:
AFFIDAVIT:
We hereby confirm that the information shown above confirms the identity of the Authorized Signatures. Furthermore, I will
inform Commonwealth Bank on a timely matter of any change concerning the information described above.
Confirmo que se ha cumplido, en todo lo posible, con la revisión de la identidad del/los arriba mencionado(s) firmante(s).
Además, me comprometo a informar a Commonwealth Bank sin demora sobre cualquier cambio concerniente con la
identidad de dicho(s) firmante(s).
Page 4
ORIGIN OF FUNDS / ORIGEN - PROCEDENCIA DE FONDOS
I ___________________________________________, hereby declare that the amount of
___________________ US$
EUR€
to be deposited on the Account open wit
Commonwealth Bank has been obtained by me from the following activity:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Yo, ________________________________________, declaro por el presente que la cantidad
EUR€
total de US$
________________, a ser depositada en la cuenta abierta con
Commonwealth Bank, representa fondos obtenidos por mi los cuales proceden de la siguiente
actividad:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
USAGE OF FUNDS / DESTINO - APLICACION DE FONDOS
I___________________________________________, hereby declare that the funds in US$
or EUR€
to be debited from the Account open with Commonwealth Bank will be used
for the following activity:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Yo, _______________________________________, declaro que los fondos en US$
EUR€
a
o
ser debitados de la cuenta abierta con Commonwealth Bank, representa
fondos destinados para:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
BANKING ACTIVITY / ACTIVIDAD BANCARIA
The following questions are regarding your future usage of the account with Commonwealth
Bank / Las siguientes preguntas son sobre el uso futuro que le va a dar a la cuenta en el
Commonwealth Bank:
1. Montlhy volume of credits to be received in the account / Volumen mensual aproximado en
Créditos que recibirá en la cuenta
US$
EUR€
________________________________________
2. Monthly volume of debits to be executed from the account / Volumen mensual aproximado en
debitos que tendrá en la cuenta
US$
EUR€
________________________________________
3. Number of credit transactions to be executed in the account / Numero aproximado de
transacciones mensuales de Crédito en cuenta
Number of Transactions / Numero de Transacciones____________________________
4. Number of debit transactions to be executed from the account / Numero aproximado de
transacciones mensuales de debito en cuenta
Number of Transactions / Numero de Transacciones____________________________
5. Maximum Credit Volume / Volumen de créditos en cuenta en meses de mayor actividad
US$
EUR€
________________________________________
6. Maximum Debit Volume / Volumen de debitos en cuenta en meses de mayor actividad
US$
EUR€
________________________________________
7. Maximum number of credit transactions / Numero de transacciones de Crédito en cuenta en
meses de mayor actividad:
Number of Transactions / Numero de Transacciones____________________________
8. Maximum debit transactions / Numero de transacciones de Debito en cuenta en meses de
mayor actividad:
Number of Transactions / Numero de Transacciones____________________________
Date / Fecha:
Passport #:
Signature / Firma:
-VYT
7"%.
9L]-LIY\HY`
+LWHY[TLU[VM[OL;YLHZ\Y`
0U[LYUHS9L]LU\L:LY]PJL
#ERTIFICATEOF&OREIGN3TATUSOF"ENEFICIAL/WNER
FOR5NITED3TATES4AX7ITHHOLDING
64)5V
:LJ[PVUYLMLYLUJLZHYL[V[OL0U[LYUHS9L]LU\L*VKL
:LLZLWHYH[LPUZ[Y\J[PVUZ
.P]L[OPZMVYT[V[OL^P[OOVSKPUNHNLU[VYWH`LY+VUV[ZLUK[V[OL09:
+VUV[\ZL[OPZMVYTMVY!
s (<:JP[PaLUVYV[OLY<:WLYZVUPUJS\KPUNHYLZPKLU[HSPLUPUKP]PK\HS
s (WLYZVUJSHPTPUN[OH[PUJVTLPZLMMLJ[P]LS`JVUULJ[LK^P[O[OLJVUK\J[
VMH[YHKLVYI\ZPULZZPU[OL<UP[LK:[H[LZ
s (MVYLPNUWHY[ULYZOPWHMVYLPNUZPTWSL[Y\Z[VYHMVYLPNUNYHU[VY[Y\Z[ZLLPUZ[Y\J[PVUZMVYL_JLW[PVUZ
s (MVYLPNUNV]LYUTLU[PU[LYUH[PVUHSVYNHUPaH[PVUMVYLPNUJLU[YHSIHURVMPZZ\LMVYLPNU[H_L_LTW[VYNHUPaH[PVU
MVYLPNUWYP]H[LMV\UKH[PVUVYNV]LYUTLU[VMH<:WVZZLZZPVU[OH[YLJLP]LKLMMLJ[P]LS`JVUULJ[LKPUJVTLVY[OH[PZ
JSHPTPUN[OLHWWSPJHIPSP[`VMZLJ[PVUZJ VYIZLLPUZ[Y\J[PVUZ
5V[L! ;OLZLLU[P[PLZZOV\SK\ZL-VYT>),5PM[OL`HYLJSHPTPUN[YLH[`ILULMP[ZVYHYLWYV]PKPUN[OLMVYTVUS`[V
JSHPT[OL`HYLHMVYLPNUWLYZVUL_LTW[MYVTIHJR\W^P[OOVSKPUN
s (WLYZVUHJ[PUNHZHUPU[LYTLKPHY`
5V[L! :LLPUZ[Y\J[PVUZMVYHKKP[PVUHSL_JLW[PVUZ
>,*0
>,*0VY>04@
>,*0VY>,?7
>04@
0KLU[PMPJH[PVUVM)LULMPJPHS6^ULY :LLPUZ[Y\J[PVUZ
7HY[0
5HTLVMPUKP]PK\HSVYVYNHUPaH[PVU[OH[PZ[OLILULMPJPHSV^ULY
;`WLVMILULMPJPHSV^ULY!
.YHU[VY[Y\Z[
*LU[YHSIHURVMPZZ\L
0UZ[LHK\ZL-VYT!
>
*V\U[Y`VMPUJVYWVYH[PVUVYVYNHUPaH[PVU
0UKP]PK\HS
*VYWVYH[PVU
+PZYLNHYKLKLU[P[`
7HY[ULYZOPW
*VTWSL_[Y\Z[
,Z[H[L
.V]LYUTLU[
0U[LYUH[PVUHSVYNHUPaH[PVU
;H_L_LTW[VYNHUPaH[PVU
7YP]H[LMV\UKH[PVU
:PTWSL[Y\Z[
7LYTHULU[YLZPKLUJLHKKYLZZZ[YLL[HW[VYZ\P[LUVVYY\YHSYV\[L+VUV[\ZLH76IV_VYPUJHYLVMHKKYLZZ
*V\U[Y`KVUV[HIIYL]PH[L
*P[`VY[V^UZ[H[LVYWYV]PUJL0UJS\KLWVZ[HSJVKL^OLYLHWWYVWYPH[L
4HPSPUNHKKYLZZPMKPMMLYLU[MYVTHIV]L
*P[`VY[V^UZ[H[LVYWYV]PUJL0UJS\KLWVZ[HSJVKL^OLYLHWWYVWYPH[L
*V\U[Y`KVUV[HIIYL]PH[L
<:[H_WH`LYPKLU[PMPJH[PVUU\TILYPMYLX\PYLKZLLPUZ[Y\J[PVUZ
::5VY0;05
-VYLPNU[H_PKLU[PM`PUNU\TILYPMHU`VW[PVUHS
,05
9LMLYLUJLU\TILYZZLLPUZ[Y\J[PVUZ
*SHPTVM;H_;YLH[`)LULMP[ZPMHWWSPJHISL
7HY[00
0JLY[PM`[OH[JOLJRHSS[OH[HWWS`!
H
;OLILULMPJPHSV^ULYPZHYLZPKLU[VM
I
0MYLX\PYLK[OL<:[H_WH`LYPKLU[PMPJH[PVUU\TILYPZZ[H[LKVUSPULZLLPUZ[Y\J[PVUZ
J
;OLILULMPJPHSV^ULYPZUV[HUPUKP]PK\HSKLYP]LZ[OLP[LTVYP[LTZVMPUJVTLMVY^OPJO[OL[YLH[`ILULMP[ZHYLJSHPTLKHUKPM
HWWSPJHISLTLL[Z[OLYLX\PYLTLU[ZVM[OL[YLH[`WYV]PZPVUKLHSPUN^P[OSPTP[H[PVUVUILULMP[ZZLLPUZ[Y\J[PVUZ
K
;OLILULMPJPHSV^ULYPZUV[HUPUKP]PK\HSPZJSHPTPUN[YLH[`ILULMP[ZMVYKP]PKLUKZYLJLP]LKMYVTHMVYLPNUJVYWVYH[PVUVYPU[LYLZ[MYVTH
<:[YHKLVYI\ZPULZZVMHMVYLPNUJVYWVYH[PVUHUKTLL[ZX\HSPMPLKYLZPKLU[Z[H[\ZZLLPUZ[Y\J[PVUZ
L
^P[OPU[OLTLHUPUNVM[OLPUJVTL[H_[YLH[`IL[^LLU[OL<UP[LK:[H[LZHUK[OH[JV\U[Y`
;OLILULMPJPHSV^ULYPZYLSH[LK[V[OLWLYZVUVISPNH[LK[VWH`[OLPUJVTL^P[OPU[OLTLHUPUNVMZLJ[PVUIVYIHUK^PSSMPSL
-VYTPM[OLHTV\U[Z\IQLJ[[V^P[OOVSKPUNYLJLP]LKK\YPUNHJHSLUKHY`LHYL_JLLKZPU[OLHNNYLNH[L
:WLJPHSYH[LZHUKJVUKP[PVUZPMHWWSPJHISL·ZLLPUZ[Y\J[PVUZ!;OLILULMPJPHSV^ULYPZJSHPTPUN[OLWYV]PZPVUZVM(Y[PJSL
VM[OL
[YLH[`PKLU[PMPLKVUSPUL HHIV]L[VJSHPTH
YH[LVM^P[OOVSKPUNVUZWLJPM`[`WLVMPUJVTL!
,_WSHPU[OLYLHZVUZ[OLILULMPJPHSV^ULYTLL[Z[OL[LYTZVM[OL[YLH[`HY[PJSL!
5V[PVUHS7YPUJPWHS*VU[YHJ[Z
7HY[000
0OH]LWYV]PKLKVY^PSSWYV]PKLHZ[H[LTLU[[OH[PKLU[PMPLZ[OVZLUV[PVUHSWYPUJPWHSJVU[YHJ[ZMYVT^OPJO[OLPUJVTLPZUV[ LMMLJ[P]LS`
JVUULJ[LK^P[O[OLJVUK\J[VMH[YHKLVYI\ZPULZZPU[OL<UP[LK:[H[LZ0HNYLL[V\WKH[L[OPZZ[H[LTLU[HZYLX\PYLK
7HY[0=
*LY[PMPJH[PVU
<UKLYWLUHS[PLZVMWLYQ\Y`0KLJSHYL[OH[0OH]LL_HTPULK[OLPUMVYTH[PVUVU[OPZMVYTHUK[V[OLILZ[VMT`RUV^SLKNLHUKILSPLMP[PZ[Y\LJVYYLJ[HUKJVTWSL[L0
M\Y[OLYJLY[PM`\UKLYWLUHS[PLZVMWLYQ\Y`[OH[!
0HT[OLILULMPJPHSV^ULYVYHTH\[OVYPaLK[VZPNUMVY[OLILULMPJPHSV^ULYVMHSS[OLPUJVTL[V^OPJO[OPZMVYTYLSH[LZ
;OLILULMPJPHSV^ULYPZUV[H<:WLYZVU
;OLPUJVTL[V^OPJO[OPZMVYTYLSH[LZPZHUV[LMMLJ[P]LS`JVUULJ[LK^P[O[OLJVUK\J[VMH[YHKLVYI\ZPULZZPU[OL<UP[LK:[H[LZILMMLJ[P]LS`JVUULJ[LKI\[PZ
UV[Z\IQLJ[[V[H_\UKLYHUPUJVTL[H_[YLH[`VYJ[OLWHY[ULY»ZZOHYLVMHWHY[ULYZOPW»ZLMMLJ[P]LS`JVUULJ[LKPUJVTLHUK
-VYIYVRLY[YHUZHJ[PVUZVYIHY[LYL_JOHUNLZ[OLILULMPJPHSV^ULYPZHUL_LTW[MVYLPNUWLYZVUHZKLMPULKPU[OLPUZ[Y\J[PVUZ
-\Y[OLYTVYL0H\[OVYPaL[OPZMVYT[VILWYV]PKLK[VHU`^P[OOVSKPUNHNLU[[OH[OHZJVU[YVSYLJLPW[VYJ\Z[VK`VM[OLPUJVTLVM^OPJO0HT[OLILULMPJPHSV^ULYVY
HU`^P[OOVSKPUNHNLU[[OH[JHUKPZI\YZLVYTHRLWH`TLU[ZVM[OLPUJVTLVM^OPJO0HT[OLILULMPJPHSV^ULY
:PNU/LYL
:PNUH[\YLVMILULMPJPHSV^ULYVYPUKP]PK\HSH\[OVYPaLK[VZPNUMVYILULMPJPHSV^ULY
+H[L44++@@@@
*HWHJP[`PU^OPJOHJ[PUN
(--0+(=0;6-<5*/(5.,+:;(;<:<UKLYWLUHS[PLZVMWLYQ\Y`0KLJSHYL[OH[0OH]LL_HTPULKHUKZPNULK[OLHIV]L-VYT>),5HUK[OH[[OL
PUMVYTH[PVUHUKJLY[PMPJH[PVUZJVU[HPULK[OLYLPUYLTHPULK[OLZHTLHUK\UJOHUNLKMVY[OLWLYPVKILNPUUPUN1HU\HY`VYSH[LYHJJV\U[VWLUPUN
KH[L[V[OLWYLZLU[HUK^LYL[Y\LJVYYLJ[HUKJVTWSL[LK\YPUN[OH[WLYPVK
:PNU/LYL
-VY7HWLY^VYR9LK\J[PVU(J[5V[PJLZLLZLWHYH[LPUZ[Y\J[PVUZ
:PNUH[\YL*HWHJP[`
*H[5VA
-VYT
>),5
9L]
W8 Annex
Individuals
NAME:
YES
NO
Are you a US Person?
If yes, what type of US Person
Do you have more than one nationality?
If yes, please indicate current nationality/nationalities
Name
Date
For Tax purposes US PERSONS include:
• US citizens; Individuals resident in the US based on number of days spent there; US green card holders (even if the green
card has expired); US created corporations; US created partnerships; US estates and trusts; Virtually everyone born in the US
DOCUMENT CHECK LIST - PERSONAL CUSTOMERS
CUSTOMER NAME:
Comply with minimum amount per product / Cumplir con el monto mínimo de apertura
Account Opening Form / Formato de Apertura
Tax ID / Registro de Informacion Fiscal
W8 Ben Format / Formato W8 Ben
Source of Funds Declaration Form / Planilla de Procedencia de Fondos
Financial Activity Form /Planilla de Actividad Financiera
2 Signature Cards / 2 Tarjetas de firmas
An original Bank Reference indicating the average amount managed in the account and years of activity / Una
Referencia Bancaria en original, indicando antigüedad y los promedios manejados en la cuenta
Copy of valid ID and Passport from all authorized signatures /Copia del Documento de Identidad y Pasaporte
vigente y legible para todas las firmas autorizadas
Prove of Residency (Utility Invoice) / Prueba de Residencia (Recibo de Servicio Publico)