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Anti-Money Laundering
Governing Data Exchange
Anti-Money Laundering - Client Due Diligence 5.0
Required in accordance with the Data Protection Act 2018 (DPA 2018) and anti-money laundering compliance with HM Revenue & Customs.
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Title
*
Mr.
Mrs.
Miss.
Ms.
Dr.
Name
*
First
Last
Have you ever used a different name?
*
-
No
Yes
Former Name
*
First
Last
Gender
*
Male
Female
I'd rather not say
Marital Status
*
-
Single
Married
Civil Partnership
Cohabiting
Widowed
Surviving Civil Partnership
Separated
Divorced
Dissolved Civil Partnership
Date of Birth
*
DD
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MM
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YYYY
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2023
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1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Country of residence
*
United Kingdom
Other
Please state Country of residence
*
Are you a politically exposed person (PEP) or potentially a PEP?
*
-
No
Yes
Nationality
*
Occupation
*
National Insurance Number (NINO)
*
Do you have a Unique Tax Reference (UTR
*
-
No
Yes
Unique Taxpayer Reference (UTR)
*
Please provide your UTR
Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Phone
*
Email
*
Identity Evidence
*
Current Valid Signed Passport
Valid Photo-card Driving License
National Identity Card
Firearms Certificate or Shotgun License
British Army Identity Card
Residence Permit Card
Other (Custom Type)
A valid photo identity is required, please upload document in the section below.
Enter Custom Name
*
Upload Photo Identity
*
Click or drag files to this area to upload.
You can upload up to 2 files.
Sources of Wealth and Funds
*
Self - Employment Income
Employment Income
UK Land & Property Income
Capital Gains Made in Year
Base Cost/Improvements and Sale/Purchase Cost Information
Savings Interest
Dividend Income
Foreign Income
PPI Repayments or Compensation
Other (Custom Name)
Please select all relevant sources of income
Enter Custom Name
*
Self - Employment Income (£)
*
Estimated annual Income
Employment Income (£)
*
Estimated annual Income
UK Land & Property Income (£)
*
Estimated annual Income
Capital Gains Made in Year (£)
*
Estimated annual Income
Base Cost/Improvements and Sale/Purchase Cost Information (£)
*
Estimated annual Income
Savings Interest (£)
*
Estimated annual Income
Dividend Income (£)
*
Estimated annual Income
Foreign Income (£)
*
Estimated annual Income
PPI Repayments or Compensation (£)
*
Estimated annual Income
Other (£)
*
Estimated annual Income
As per GDPR regulations, I understand that by ticking the box below, I am providing consent to allow my information to be held on file
*
I provide consent
Signature
Clear Signature
I herby confirm that the data provided is correct and accurate.
*
I provide consent to the use and processing of my data.
Additional Information
AML 5.0 Integration Fee
Price:
£ 60.00
Please note that a one-off integration fee is required in order to complete the anti-money laundering checks and client due diligence report
Payment Details
*
Card
Name on Card
Phone
Submit
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