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PERSONAL ACCOUNT

Customer Details

Name *

Middle name

Last name *

Gender *

Country of Birth *

Citizenship *

Marital Status *

Passport *

Address *

City *

ZIP

Country *

Phone *

Email *

PEP (POLITICALLY EXPOSED PERSON) *YesNo

Signatories

Name *

Middle name

Last name *

Gender *

Country of Birth *

Citizenship *

Marital Status *

Passport *

Address *

City *

ZIP

Country *

Phone

Email *

PEP (POLITICALLY EXPOSED PERSON) *YesNo

Financial Information

Account number

Account Type

Financial Institution

Currency

Opening Account Information

Opening Amount *

Account Type *

Source of Funds *

Currency *

In case of choosing Cryptocurrency please indicate *

Transactional Profile

Outgoing (Per Month)

Transaction Number *

Average Amount Transfers *

Incoming (Per Month)

Transaction Number *

Average Amount Transfers *

Origin

Country *

Average Amount *

Beneficiaries

Country *

Average Amount *

Declaration Regarding the Lawful Origin of Funds and Assets *By affixing our signature(s) below, we solemnly declare and affirm, under penalty of perjury and pursuant to applicable laws, that all funds, securities, shares, financial instruments, assets, and/or services to be transferred, deposited, or otherwise entrusted to BANFERS INTERNATIONAL BANK & TRUST (hereinafter, “the Bank”) are of lawful origin. We further affirm that said assets are not, directly or indirectly, derived from or connected to any criminal, illicit, fraudulent, or otherwise unlawful activities, as defined under local and international laws, regulations, and conventions to which the Bank is subject. This declaration is made in good faith and with full knowledge of the legal consequences of providing false or misleading information.

Acceptance of General Terms and Arbitration Agreement *The undersigned client(s) (hereinafter, “the Client”) hereby acknowledges that they have read, fully understood, and expressly accepted the General Terms and Conditions of Contract governing the provision of products and/or services by BANFERS INTERNATIONAL BANK & TRUST. Said terms and conditions are referenced herein and form an integral part of this agreement (the “Contract”), which has been duly approved as the official framework governing the Bank’s engagements with its clients. Furthermore, the Client expressly ratifies their irrevocable intention to submit any and all disputes, controversies, or claims arising out of or relating to the contractual relationship with the Bank, including its interpretation, performance, or termination, to institutional arbitration in accordance with the provisions set forth in the Contract and pursuant to the rules of the designated arbitration body identified therein. The Client waives any right to initiate proceedings before ordinary courts, except where mandatory law provides otherwise.

Date *

Place *

Signature *

Name *

Last name *

Signature

Name

Last name

Signature

Name

Last name

SIGNATURE CARD

AUTHORIZED SIGNATURE 1 *

AUTHORIZED SIGNATURE 2

AUTHORIZED SIGNATURE 3

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