Client Veri•cation Form - Goldmoney · PDF fileIf you require assistance with any part of the form, ... (USD OR EQUIVALENT) ... files of credit reference agencies that may record

1 OF 9 • INDIVIDUAL OR JOINT HOLDING

Client Verification Form I N D I V I D U A L O R J O I N T H O L D I N G

Thank you for applying to become a verified client of Goldmoney. This form incorporates our Privacy Policy and Client Agreement, which, together, set out the terms under which Goldmoney provides services.

Please read each section carefully, including the checklist page, as this details the documentation which must be submitted with this form.

Additional information regarding acceptable documentation and certification can be found in the FAQ section of our website.

The completed application documents may be submitted by email in the first instance for review to [email protected]

If the documents are acceptable, we will then ask you to submit the documents in the post to one of our office addresses depending on your jurisdiction.

EUROPE

Verification Team Goldmoney 9 Bond Street St Helier Jersey, JE2 3NP Channel Islands (UK)

If you require assistance with any part of the form, please contact our dedicated Relationship Management team on:

UK & International: +44-1534-633-933 USA & Canada (Toll-Free): 1-855-583-GOLD(4653) Or email us: [email protected]

NORTH A MERIC A

Verification Team Goldmoney 305-334 Adelaide Street West Toronto Ontario, M5V 1R4 Canada

https://www.goldmoney.com/privacy-policy

https://www.goldmoney.com/client-agreement

https://www.goldmoney.com/support

mailto:inbox%40goldmoney.com%20?subject=


EXAMPLE

Please use the image below to guide you.

Surname

Given name

Date of birth

Date of issue

Date of expiration

Sex

Authority

P < < <<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<< <

White space around your ID

Corner in frame

Entire ID in frame

Corner in frame

Corner in frame Corner in frame

Is currently valid (not expired)

Clear issue date, date of birth, and expiry

Is the primary focus of your image (rather than your face in the passport).

Is clear and can be easily read.

Is not cut off, and all corners are showing.

Is one of the following accepted forms of ID:

• Passport

• National Identification Card

• Driver’s License (U.K., U.S., Canadian residents only)

Please ensure that your submitted document:

ID Requirements


SECTION 1Individual Details for Holding Owner

TITLE

FULL NAME (INCLUDING FORMER/MAIDEN NAMES)

Mr Mrs Ms Miss Dr Other

TITLE (IF MARKED OTHER)

RESIDENTIAL ADDRESS

CITY/COUNTY/STATE/DISTRICT COUNTRY ZIP/POSTAL CODE

DATE OF BIRTH (NAMED OWNERS MUST BE OVER 18 YEARS OLD)

OCCUPATION

TELEPHONE NUMBER (INCLUDING COUNTRY CODE)

NATIONALITY

ANNUAL SALARY (USD OR EQUIVALENT)

CITY AND COUNTRY OF BIRTH

TAX IDENTIFICATION NUMBER

Self Employed Unemployed Retired Student Other

CURRENT EMPLOYMENT STATUS CURRENT EMPLOYMENT STATUS (IF MARKED OTHER)

EMPLOYER’S NAME

EMPLOYER’S ADDRESS


Employed


DECLARATION

By signing this declaration, I confirm that I have read, understood and agree to be bound by the Goldmoney Client Agreement.

As the owner of the Holding in my name, I hereby authorise any additional individual(s) named in section 1 to be appointed as authorised operator(s) on my Goldmoney Holding. I confirm that Goldmoney is entitled to accept the instruction or signature of any one of the individual(s) named in section 1 for any transaction within my Holding.

I authorise Goldmoney to obtain independent verification of any information provided. Goldmoney may search files of credit reference agencies that may record each search.

SIGNATURE DATE




Please only complete this section for each additional person to be named on the Holding (use additional sheets as necessary)

SECTION 2Individual Details for Additional Owners

TITLE

FULL NAME (INCLUDING FORMER/MAIDEN NAMES)



RESIDENTIAL ADDRESS


DATE OF BIRTH (NAMED OWNERS MUST BE OVER 18 YEARS OLD)

OCCUPATION

TELEPHONE NUMBER (INCLUDING COUNTRY CODE)

NATIONALITY

ANNUAL SALARY (USD OR EQUIVALENT)

CITY AND COUNTRY OF BIRTH

TAX IDENTIFICATION NUMBER

Employed Self Employed Unemployed Retired Student Other

CURRENT EMPLOYMENT STATUS CURRENT EMPLOYMENT STATUS (IF MARKED OTHER)

EMPLOYER’S NAME

EMPLOYER’S ADDRESS



DECLARATION

By signing this declaration, I confirm that I have read, understood and agree to be bound by the Goldmoney Client Agreement.

As the owner of the Holding in my name, I hereby authorise any additional individual(s) named in section 2 to be appointed as authorised operator(s) on my Goldmoney Holding. I confirm that Goldmoney is entitled to accept the instruction or signature of any one of the individual(s) named in section 2 for any transaction within my Holding.

I authorise Goldmoney to obtain independent verification of any information provided. Goldmoney may search files of credit reference agencies that may record each search.

SIGNATURE DATE




Holding Information SECTION 3

HOLDING NUMBERS(S) (IF THE INTRODUCED CLIENT HAS AN EXISTING RELATIONSHIP WITH GOLDMONEY)

PRIMARY EMAIL ADDRESS SECONDARY EMAIL ADDRESS

REASON FOR OPENING A HOLDING WITH GOLDMONEY

CURRENCY REQUIRED

VALUE OF EXPECTED ACTIVITY OVER NEXT 12 MONTHS (IF MARKED AS +1M+)

Diversification Recommendation Hedge against inflation Protection from currency and/or political risk

HOLDINGS ARE AVAILABLE IN THE FOLLOWING CURRENCIES

GBP NZDUSD HKDEUR CADAUD CHF JPY

VALUE OF EXPECTED ACTIVITY OVER NEXT 12 MONTHS (USD OR EQUIVALENT)

0-150k 150-500k 500k-1M 1M+ (please specify)

BANK NAME FOR FUNDING THIS HOLDING

BANK ADDRESS


SOURCE OF FUNDS (E.G. SALARY, BONUS, SALE OF PROPERTY, INHERITANCE, ETC.) DO YOU INTEND TO FUND USING VIRTUAL CURRENCIES?

Yes No


Please provide the following instructions to your certifier:

1. The original document must be clearly photocopied and photographs must be copied so that the facial features in the photocopy are clearly visible.

2. Please write/stamp the following on the copy: “I certify that this is a true and correct copy of an original document in the name of [insert name of applicant]”.

3. Where the copy is of a document containing a photograph, please write/stamp the following on the copy: “I certify that this is a true and correct copy of an original document in the name of [insert name of applicant] and a true likeness”.

4. Sign your name below the above statement and date the certification. Either print your name, position, and any identification number below your signature or stamp each certified copy with your business stamp (if applicable).

Certifier’s Details SECTION 4

Please enter the details of the professional who certified your documents as true copies below.

TITLE



CERTIFIER’S FULL NAME AND WEBSITE (IF APPLICABLE)

OCCUPATION PROFESSIONAL MEMBERSHIP HELD ID NUMBER WITH PROFESSIONAL BODY

CERTIFIER’S ADDRESS


SIGNATURE DATE

CERTIFIER’S TELEPHONE NUMBER CERTIFIER’S EMAIL ADDRESS


Checklist SECTION 5

Please ensure you complete the checklist before submitting this form. Missing information may delay the verification process. Documents not in English must be professionally translated.

Frequently Asked Questions: What is a certified copy? What proof of residence documents does Goldmoney accept?

Sections 1, 2 (if there is to be additional Holding owner(s)) and 3 have been completed in full

A certified copy of each applicant’s valid, non-expired passport is enclosed

Certified or original copies of 2 documents showing the residential address (proof of residence) for each applicant are enclosed

Certified or original source of funds documentation, which could include:

• signed letter from employer confirming position and salary

• pay slip from employer

• bank account statement showing salary payment

• sales contract (for sale of business/property)

• trust deeds/solicitor letters (inheritance)

http://goldmoney.com/support#holding-and-documentation-10

http://goldmoney.com/support#holding-and-documentation-6