Data collection sheet
for individuals

Please fill out the following form completely.

1. Personal details

2. Information on the purpose and nature of the business relationship / transaction (please tick as appropriate)

3. Explanations (please tick as appropriate)

4. Politically Exposed Persons (PEP) (please tick as appropriate)

Information on politically exposed persons to whom I belong as a family member or am otherwise related:
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Family member {{ID}}

5. Information on the source of funds (please tick as appropriate)

Please upload proof of the source of funds as pdf or jpg. Maximum 10 MB per file. Multiple selection is possible.
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6. Signature

Notes on uploading your signature: The file must be uploaded as a png or jpg. Please crop your signature as shown in the example.
I enclose a copy of an official ID card (both sides) as pdf or jpg with this form and confirm with my signature that all information in this form is correct and complete.