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PATRIMONIUM FIDUCIA

TO BE EXECUTED IN BLOCK CAPITALS

Confidential questionnaire

CLIENTE:
EMAIL:
Name of the Company: (the “Company”)

PART I “COMPANY”

Type of Company:

Other:
1.- BENEFICIAL OWNER (INDIVIDUALS ONLY, NO ENTITIES) IN CASE OF OF A TRUST, PLEASE FILL IN WITH THE SETTLOR’S DATA, AND COMPLETE PART II
Full name:  
Address:  
Nationality: Date of birth:
Telephone: Fax:
Passport number: e-mail:
2.- MAILING ADDRESS:
Full name:  
Address:  
Nationality: Date of birth:
Telephone: Fax:
Passport number: e-mail:
3.- REGISTERED PARTNER (INDIVIDUAL OR ENTITY) IN THE CASE OF A TRUST PLEASE FILL IN WITH THE TRUSTEE’S DATA
Full name:  
Address:  
Nationality: Date of birth:
Telephone: Fax:
Passport number: e-mail:
4.- DESCRIPTION OF THE ACTIVITIES OF THE COMPANY (as detailed as possible):
5.-POWER OF ATTORNEY (INDIVIDUALS ONLY, NO ENTITIES)
Full name:  
Address:  
Nationality: Date of birth:
Telephone: Fax:
Passport number: e-mail:

Attachments:

  • Certified Passports Copies
  • Bank Reference
  • Professional Reference
  • Proof of residential address.

Please make payment to:

PATRIMONIUM LIMITED
Citibank NA
111 Wall Street, New York, NY 10005
ABA:   021000089
A/c 30604518
In the name of
CITIGROUP GLOBAL MARKETS

For further credit to:
A/c 338-12331-17-603
In the name of
PATRIMONIUM LIMITED

PART II “TRUST”

NAME OF TRUST:
1.        Settlor:
Name of Settlor:
Address of Settlor:
Passport Copy enclosed
2.         Protector:
Name of Protector:
Address of Protector:
Passport Copy enclosed
3.         Beneficiary/ies
Name of 1st named Beneficiary:
Address of 1st named Beneficiary/ies
Passport Copy enclosed
Name of 2nd named Beneficiary/ies
Address of 2nd named Beneficiary/ies
Passport copy enclosed

If further beneficiaries are to be added, please complete on separate sheet.
4.-Assets of the Trust:
5.-Any other information deemed relevant to the establishment of the trust:

PART III: SOURCE OF WEALTH

Family Fortune
    Specify: e.g. (former) entrepreneurial, inheritance, other resources; if possible detailed and documented description
Active entrepreneurial Company name Short description of business activities Statutory seat Name company website (if applicable)
Former entrepreneurial If “sold to third party”: Name of purchaser and approximate date If other: Detailed and documented description
Income
    Profession Name employer
Other Detailed and documented description
Place and date:
Name:

PART IV: INDEMNITY LETTER

Date:

TO THE DIRECTORS

 

 

 

We refer to your appointment as Directors of the above Company.

We confirm that we shall indemnify you during the entire period in which you act as a Director of the Company against all acts, neglects or defaults of any other officer, manager, servant or agent of the Company and for any and every loss and liability including all costs, expenses and liabilities incurred by you in defending any proceedings in which judgment is given in your favour or in which you are acquitted, or which are otherwise disposed of without any finding or admission of any material breach of duty on your part.

 

Yours faithfully,

 

PART V – BANK ACCOUNT(S)

 

Name of Bank(s):
Address of Bank or Branch:
Banker name/ contact details/ Email address:
Currency/Currencies:
Type of account(s)
Correspondence Address for Bank account if different to registered address:
Estimated Annual Turnover:
Estimated number of Debits per Year & Typical Value of One:

Estimated number of Credits per Year & Typical Value of One:
List of Trading Countries

Country

Approximate percentage of trade %

List of Trading Counterparties

Trading counterparties/proposed trading counterparties

Approximate percentage of trade %

SIGNING ARRANGEMENTS
Note: Where we are providing one or all the Officers in the company the appointed authorised signatories must be known to Pearse Trust.
The Authorised Signatories to be appointed are as follows:
Where client/client representatives are selected please specify the name(s) of who will sign and the signing powers e.g. any two signing jointly or individual signatory powers.
* Please also provide a notarised copy of current passport/ID card for each proposed authorised signatory.

PATRIMONIUM
HORNEDO Y RENOVALES
PATRIMONIUM
CONSULTORES INTEGRADOS
PATRIMONIUM
PROTECCIÓN LEGAL