Dear Sirs, Date, (the Applicant) We, the undersigned, request and authorise you to open an account or accounts as may from time to time be requested in writing in the name of the above which is registered and/or existing under the laws of: Country incorporated on DD/MM/YYYY and having registration number Our registered office address is: Office / Correspondence Address (If different) Activities of the Applicant The main geographical area of business is: Tel. No. Fax No. E-Mail Contact BENEFICIAL OWNERS (List Names of Owners / Controllers of the Applicant) Clearly indicate below the name of the ultimate beneficial owners and their ownership and / or control in the company I/We enclose the relevant documents listed in the checklist at the back of this form. Duly authorised For and on behalf of Name of Entity Duly authorised For and on behalf of Name of Entity IIG BANK (MALTA) LTD is a limited liability company licensed to carry out the activities of a credit institution by the Malta Financial Services Authority 1
1. APPOINTMENT OF BANKERS Certified extract of a resolution approved and adopted by the board of directors/partners/administrators of: Name of Applicant Registered Address of Applicant Place (the Applicant ) held in IT WAS UNANIMOUSLY RESOLVED THAT: (1) I I G Bank (Malta) Ltd (the Bank ) be appointed bankers of the Applicant; on the Date (2) The Applicant opens an account or accounts with the Bank in any currency and upon any terms deemed desirable; (3) The Applicant shall accept to be bound by the Bank s terms and conditions; (4) Name of Co Rep Name of Co Rep Name of Co Rep and/or and/or acting jointly and/or severally (the Authorised Signatory(ies) ) be hereby authorised to open and thereafter operate the aforesaid account(s) with the Bank and give or procure all and any form of instruction, order, mandate or documents to the Bank in the course of so doing. This authority is binding until the Bank receives a duly certified copy of a resolution rescinding or amending the same; (5) The Authorised Signatory(ies) are hereby empowered to act and sign on behalf of the Applicant in all transactions including the request of loans and signatures on security documents pertaining to credit facilities with the Bank; (6) The Bank, at its discretion, may act on any written instructions given by the Authorised Signatory(ies) on behalf of the Applicant and to accept any receipts or other documents in relation to the account, transactions or affairs of the Applicant provided that they are signed in accordance with these resolutions; (7) The Applicant indemnifies the Bank against any loss, damages, costs, claims or demand (including any legal costs) incurred by the Bank as a result of, or arising in connection with, the reliance by the Bank on any instructions or communications received by it from the Authorised Signatory(ies); (8) The Applicant shall provide the Bank with up-to-date information and documents as may be required by the Bank from time to time in order for the Bank to comply with its anti-money laundering obligations; (9) In accordance with the Bank s terms and conditions, the Applicant may grant any form of pledge, right of retention, or other preferential security right in favour of the Bank in relation to the aforesaid account(s); and (10) The Chairman or any one director/partner/administrator or the Company Secretary (*in case of Companies) be authorized to issue a certified extract of these resolutions and to provide a copy of same to the Bank Certified true extract Chairman / Director / Partner/Administrator / Company Secretary * Applicant Signature *Delete as Applicable IIG BANK (MALTA) LTD is a limited liability company licensed to carry out the activities of a credit institution by the Malta Financial Services Authority 2
2. WHO OWNS AND RUNS THE COMPANY? Please add details of all Directors, Partners, Signatories, as well as any Shareholders with a holding greater than 25, and any other operators use an additional blank sheet if necessary. a. twelve months? YES NO b. c. IIG BANK (MALTA) LTD is a limited liability company licensed to carry out the activities of a credit institution by the Malta Financial Services Authority 3
2. WHO OWNS AND RUNS THE COMPANY? (cont.) Please add details of all Directors, Partners, Signatories, as well as any Shareholders with a holding greater than 25, and any other operators use an additional blank sheet if necessary. d. e. f. IIG BANK (MALTA) LTD is a limited liability company licensed to carry out the activities of a credit institution by the Malta Financial Services Authority 4
3. ADDITIONAL INFORMATION (Tick as applicable) Does the Company have any U.S. registration? YES NO Is the Company Subject to any U.S. Tax? YES NO Does the Company regularly transfer funds to/from the U.S. YES NO 4. PRINCIPAL BANKERS Name Address Account Number I/We hereby authorise IIG Bank (Malta) Ltd to contact our bankers stated above for the purposes of obtaining a reference on us and authorise our Bankers to debit our account with the appropriate fee to cover this service 5. ACCOUNT DETAILS (Tick as applicable) PRIME ACCOUNT CURRENCY EURO ( ) GBP ( ) USD ($) TERM DEPOSIT CURRENCY EURO ( ) GBP ( ) USD ($) AMOUNT TERM RATE INTEREST FREQUENCY Quarterly Half-Yearly Annually Maturity CHEQUE PAYABLE TO: TRANSFER TO (Name of Bank): BIC CODE IBAN 6. TAX DECLARATION (Tick as applicable) Companies Resident in Malta Withholding Tax Deducted * YES NO* Company s Tax Identification Number *I/We hereby inform you that income tax on interest receivable on the above mentioned account(s) will be payable to me/us in accordance with the Income Tax Act. I/We do not want the Final Withholding Tax deducted from the interest payable to me/us. Furthermore, I/we authorise you to inform the Commissioner of Inland Revenue of the amount of interest paid to me/us in accordance with the Income Tax Act / European Union Council Directive 2003/48/EC. IIG BANK (MALTA) LTD is a limited liability company licensed to carry out the activities of a credit institution by the Malta Financial Services Authority 5
7. SECURE COMMUNICATION INSTRUCTIONS* (Tick as applicable and complete relevant separate form) I / We wish to use: INTERNET BANKING email / FAXED INSTRUCTIONS 8. DOCUMENTATION ISSUED TO CLIENT Prime T & C s Term Deposit T & C s Tariff of Charges Interest rates Other 9. DATA PROTECTION In terms of the Data Protection Act (Chapter 440 of the Laws of Malta), the Bank will process the above data and any other data which you subsequently give the Bank in any manner, for the following purposes, namely: To give you statements and provide its products and services; For internal assessment and analysis ; For the detection and prevention of fraud and other criminal activity which the Bank is bound to report; To develop and improve the Bank s services; For direct marketing, such as to inform you, by mail, telephone, fax, e-mail or other electronic means, about other products and services supplied by the Bank, its subsidiaries, associates, agents and by carefully selected third parties and for research purposes. Please note that your personal data may be disclosed to, exchanged with or processed by all employees of the Bank, its subsidiaries, associates and agents, including third parties entrusted with handling bulk mail in Malta, EEA Member States or the United States of America, for the above purposes only. Personal data in relation to transactions effected via SWIFT (Society for Worldwide Interbank Financial Telecommunications) may be required to be disclosed to the United States authorities in order to comply with legal requirements applicable in the United States for the prevention of crime. You have the right to request the Bank to inform you about the personal data held about you that is processed and to request its correction where necessary. Furthermore, please inform us in writing if you do not wish that we process your personal data for the purpose of direct marketing. Whilst the Bank may periodically request you to re-confirm the above data, you should inform the Bank immediately if such data has changed. 10. DECLARATION The Applicant hereby confirms that it has received and read a copy of I I G Bank (Malta) Ltd s (the Bank ) terms and conditions governing the account(s) and it also agrees to be bound by the general terms and conditions (the Terms and Conditions ) as they may be amended from time to time, in its relationship with the Bank. The Applicant specifically agrees and confirms that the Bank shall be entitled to disclose and/or procure information pertaining to the Applicant as and when it is deemed necessary by the Bank or required by regulatory authorities. The Applicant further declares, confirms and agrees: a. That all the particulars and information given in this application form and in other ancillary documentation are true, correct, complete and up to date in all respects and that no information has been withheld; b. That no petition has been presented for its winding up or liquidation, or analogous proceedings, nor have any creditors entered into any arrangement; c. That it has not, at any time, defaulted under any loan obtained from any person; d. That the provision of any false or misleading information or the suppression of any material fact will render the Applicant s account liable for termination and further action; e. To indemnify the Bank and its successors or assigns, if any representation or declaration made hereunder or in any other ancillary document is incorrect, false, or misleading in any way; f. To forthwith provide the Bank with up-to-date information and documents as may be required by the Bank from time to time in order for the Bank to comply with its anti-money laundering obligations; g. To forthwith notify the Bank of any changes /updates made to any of the documents being submitted with this application form and to furnish to the Bank a copy of such documents as amended; h. To forthwith inform the Bank in case of any significant changes to the Applicant s ownership and or/legal structure; and i. To furnish to the Bank such documents and particulars as may be reasonably requested by the Bank from time to time. Duly authorized for and on behalf Duly authorised for and on behalf Name of Entity Name of Entity Signatures verified by* Signature of Certifier Name of Certifier Stamp *Signatures to be verified when application is not completed by an IIG Representative IIG BANK (MALTA) LTD is a limited liability company licensed to carry out the activities of a credit institution by the Malta Financial Services Authority 6
11. AUTHORISED SIGNATORIES (Please use a blank additional sheet for multiple signatories if necessary) Signing Instructions (Tick as appropriate) Please accept the signatures of: ANY ONE ALL OTHER (Please specify) FOR OFFICE USE ONLY (Tick as applicable) FACE TO FACE MAIL E-MAIL//NTERNET WEALTH MANAGEMENT BUSINESS 12. SUPPORTING DOCUMENTATION CHECK LIST Your account may be opened: a. IN PERSON Visit one of our offices with a completed account application form or allow one of our staff to complete this for you. b. BY POST** Simply download and complete your application form, sending to one of our offices with any necessary additional documentation: * All postal applications will be subject to a Banker s Reference and so please ensure that the relevant section of the application has been completed with these details. ** Please see Page 8 of this application for the relevant documents required for your specific type of entity. IIG BANK (MALTA) LTD is a limited liability company licensed to carry out the activities of a credit institution by the Malta Financial Services Authority 7
12. SUPPORTING DOCUMENTATION CHECK LIST (cont.) To open your account either visit our offices, where we will be pleased to complete your account application form, or; download and print the application form available on our website and send it to us complete with original signature(s) together with the requisite additional documents required (please see below). Please make copies of all additional documents and have them signed by a suitable certifier(*) as true and accurate duplicates of the originals bearing the certifier s signature. They should add their company stamp to the copy, clearly marking I certify this to be a true copy of the original document presented to me, adding their full name, dating and signing each copy. They should also verify your signature on the bottom of page 6 of the application form. (*) A suitable certifier may be a senior civil servant, a bank officer, a registered accountant, a registered attorney/lawyer, a notary public or any financial professional recognized by a regulatory body. a. For a Sole Trader Original Photo Identification Document or Certified Copies of such documents signed by a Suitable Certifier (*) Valid Passport/I D Card Original Verification Document of (document must be no more than 3 months old) or Certified Copies of such documents signed by a Suitable Certifier (*) Utility Bill Bank Statement b. For a Corporate Entity Certificate of Incorporation/Registration Memorandum and Articles of Association Copy of ownership/control chart of the company (where applicable) Appointment of Bankers (fill the resolution contained in this form or submit separate resolution) For each of the authorised signatories/directors/partners/administrators/beneficial owners (beneficial owners are natural persons who own or control more than 25 of the shares or voting rights): Original Photo Identification Document or Certified Copies of such documents signed by a Suitable Certifier (*) Valid Passport/I D Card Original Verification Document of (document must be no more than 3 months old) or Certified Copies of such documents signed by a Suitable Certifier (*) Utility Bill Bank Statement c. For a Limited Partnership/Association/Other Organisation Certificate of Limited Partnership/Formation Statutes/Partnership Agreement/Other Documents attesting to formation Evidence of partnership holding/list of Members/Administrators For each of the persons who hold 10 or more of the ownership units in a partnership, member, administrator or signatory of the applicant: Original Photo Identification Document or Certified Copies of such documents signed by a Suitable Certifier (*) Valid Passport/I D Card Original Verification Document of (document must be no more than 3 months old) or Certified Copies of such documents signed by a Suitable Certifier (*) Utility Bill Bank Statement d. For a Trust Copy of the Trust Deed For each of the Settlor(s) and Trustees of the Trust: Original Photo Identification Document or Certified Copies of such documents signed by a Suitable Certifier (*) Valid Passport/I D Card Original Verification Document of (document must be no more than 3 months old) or Certified Copies of such documents signed by a Suitable Certifier (*) Utility Bill Bank Statement IIG BANK (MALTA) LTD is a limited liability company licensed to carry out the activities of a credit institution by the Malta Financial Services Authority 8