Know Your Client Form

Proposed Company Name

Corporate Business Development Contact

Section A-Personal Details

Surname or family name as shown in passport*

First or given names as shown in passport

Title

Mrs Ms Miss Dr

Others(Please Specify)

Other names you are known by or have been known by

Gender

Male

Female

Date of birth (day/month/year)*

City/town of birth

Country of birth

Please list any other citizenships currently held

Passport number

Country

Issue date

Expiry date

Place of issue

Name and address for your correspondence(or agents details)

Telephone

Telephone(Mobile)

Fax

Email*

Your current office or work address

Telephone

Telephone(mobile )

Fax

Address in your home country(if different from above)

Telephone

Telephone(Mobile)

Fax

What is your preferred means of Telephone(mobile)communication in relation to this KYC Form ?

Letter

1. SECTION B-BUSINESS EXPERIENCE

How many years of business experience do you have?

Please fill in the following sections to show your last four periods of employment.

From

What was your role ?

Employee

Business Owner

Nature of Business

Manufacturing

Trading Services

Other

Type of business/industry

Your job title/position held

Name of company/employer

Number and street name

Current telephone number

City

Country

Website Address

Company's main product/services

Geographical area of operations

Additional information(eg main customers and suppliers)

Why do you consider this experience relevant to your Application?

2. SECTION B-BUSINESS EXPERIENCE

How many years of business experience do you have?

Please fill in the following sections to show your last four periods of employment.

From

What was your role ?

Employee

Business Owner

Nature of Business

Manufacturing

Trading Services

Other

Type of business/industry

Your job title/position held

Name of company/employer

Number and street name

Current telephone number

City

Country

Website Address

Company's main product/services

Geographical area of operations

Additional information(eg main customers and suppliers)

Why do you consider this experience relevant to your Application?

3. SECTION B-BUSINESS EXPERIENCE

Please fill in the following sections to show your last four periods of employment.

From

What was your role ?

Employee

Business Owner

Nature of Business

Manufacturing

Trading Services

Other

Type of business/industry

Your job title/position held

Name of company/employer

Number and street name

Current telephone number

City

Country

Website Address

Company's main product/services

Geographical area of operations

Additional information(eg main customers and suppliers)

Why do you consider this experience relevant to your Application?

4. SECTION B-BUSINESS EXPERIENCE

Please fill in the following sections to show your last four periods of employment.

From

What was your role ?

Employee

Business Owner

Nature of Business

Manufacturing

Trading Services

Other

Type of business/industry

Your job title/position held

Name of company/employer

Number and street name

Current telephone number

City

Country

Website Address

Company's main product/services

Geographical area of operations

Additional information(eg main customers and suppliers)

Why do you consider this experience relevant to your Application?

General

Are you associated with any of their DMCC businesses?Please specify which company and your role

In order to process your KYC Form,it is essential that you include a Valid Passport copy with this document. Please tick the box below to confirm that you are returning the completed form with a valid copy of your Passport.

Yes

I hereby warrant that the information supplied by me is true and correct and acknowledge that any misrepresentation by me may result in my prosecution

Yes

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