MCP - PDF Templates

MCP

Client Information Form

Identity:

Name

Martina Borbleyova

martina@mpmonaco.com

Phone number

0639857894

Birth place

Date of birth

29/04/1992

Professional situation :

Sector of activity

Professional situation

Place of work

Personal Situation :

Other

Information regarding spouse :

Family name

Firstname

Date of birth

Place of birth

Profession

Socio-economic background :

Information on the origin of the assets

How did you build your weath?

Professional income (salaries)

Could you tell us more about how you builtup your assets?

Origin of funds

Bank information

Bank Name

Bank Address

Bank Account Name

Private Banker Name

Additional comments regarding banking information

These specific funds originate from…

Professional income (salaries,bonuses, dividends…)

Inheritance / Gift / Succession

If Yes (specify date & relationship to donor or deceased)

Savings

If Yes (specify date & relationship to donor or deceased)

If Yes (specify date & nature / sector of activity)

If Yes (specify date & relationship)

Real Estate Sale

Sale of movable property (works of art, vehicle, jewerly)

Sale of business assets or company shares

Benefit from a life insurance contract

Benefit or compensation (accident, divorce, death…)

Surrender of a life insurance / capitalization contract

Gambling winnings (casino, lotto, betting…)

Other

YES

Yes (specify nature, d

ate, home institution)

Other info

Political statuts

Do you hold or have you held important public functions in Monaco or in a foreign country during the last 12 months

If Yes (specify)

Are you, or have you been closely associated with a person holding or having held important public functions in Monaco or a foreign country during the past 12 months?

Yes (specify)

Additional comments

Certification

I certify on my honor that the sums which are or will be paid under this contract do not have a criminal origin in the sense of the regulation relating to money laundering.

YES

I certify on honor that the elements appearing on the present document

YES

Signature

About this template

Categories

Details

1 Clone

Created by

Monaco_Properties

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These templates are suggested forms only. If you're using a form as a contract, or to gather personal (or personal health) info, or for some other purpose with legal implications, we recommend that you do your homework to ensure you are complying with applicable laws and that you consult an attorney before relying on any particular form.