- Firstline requires this form to be fully completed in order to begin our client relationship with you. Its primary purpose is to ensure that the identity of our clients and their source of funds are properly verified in accordance with national legislation and international guidelines.
- Do not leave any section blank. State ‘N/A’ if we prompt you to answer anything that is not applicable to your situation. We may request additional information.
- Copies of all submitted documents should be accompanied by originals for verification. If an original is not produced, the copy must be notarised or certified by a bank officer, member of the judiciary, Member of Parliament or legal practitioner.
9. Physical Address: *
10. Mailing Address:
11. Telephone Numbers
12. Email Address
13. Bank Details (If you are not resident in T&T, we require a bank reference letter.)
Bank Reference Letter (Enc.? y/n):
B. ID VERIFICATION (If originals not submitted for verification to Firstline, copies must be notarised or certified)
2. Address Verification Required for both physical and mailing addresses. Must be no more than 3 months old.
Utility Bill (not mobile)Bank Statement
max. 10MB upload. Hold Ctrl to select multiple files for upload.
C. OCCUPATION Pay slip or job letter required as verification
6. Self-Employment If self-employed, please complete this section:
D. OUR RELATIONSHIP If you select “wealth management” in D1, please complete D5 to D7.
1. Business Activity: *
5. What is your level of direct experience in years with these different forms of investments?
E. LEGAL INFORMATION
1. Have there ever been any criminal or civil proceedings brought against you? If yes, please describe: *
2. Are you or your spouse, singularly or as part of a group, in a position of control or similarly connected to any publicly listed company of any jurisdiction? Please state details: *
F. POLITICIALLY EXPOSED PERSONS
2. If you selected any at F1, please give details here:
G. U.S. INDICIA (FATCA) The Government of T&T has agreed with the U.S. to collect data on persons with U.S. indicia
1. Please check the relevant box/es below which applies/apply to you.
Documentation Required - Doc Enc? y/n
H. REQUIRED DOCUMENTS Please enclose the following documents (originals to be seen or copies certified)
1. Two forms of current photo identification (as selected in B1) max. 10MB upload. Hold Ctrl to select multiple files for upload.
2. Proof of physical and mailing address (utility bill or bank statement 3 months to current) max. 10MB upload. Hold Ctrl to select multiple files for upload.
3. Pay slip or job letter max. 10MB upload. Hold Ctrl to select multiple files for upload.
4. Bank reference letter (if non-resident in T&T) max. 10MB upload. Hold Ctrl to select multiple files for upload.
5. If you are unable to provide a pay slip or job letter and / or you answered yes to F1, you must complete a Source of Wealth form and provide supporting documentation max. 10MB upload. Hold Ctrl to select multiple files for upload.
I. YOUR DECLARATION
I * declare that the information I have provided on this form is true and correct to the best of my knowledge. I authorise Firstline Securities Limited to obtain independent verification of any information provided in respect of this application or as may be required by law, using any legal means available to it, including but not limited to performing background checks, credit checks, and checks against lists of politically exposed persons and terrorist watch lists. I understand Firstline may be legally compelled to share my information with local or foreign regulatory organisations.
If this form has been completed by an intermediary (power of attorney or other authorised individual), Firstline requires original authorization from you on the appointment of your intermediary.