account opening

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Opening an Account
For Individuals
I. Identification and Client Information.
Name *
Registered Address *
Mailing Address *
Phone Number *
Fax Number
E-mail *
URL
Passport/Personal ID Card Details:
Number *
Series *
Issue Date *
Issuing Authority *
Date of Birth *
Place of Birth *
Country of Citizenship *
Country of Tax Residency *
Taxpayer ID (if any)
Georgian Tax ID (if available)
Do you currently have any pending litigation in Georgia, or have you ever had litigation, disputed accounts, or unresolved matters with a Georgian or other broker, investment firm, custodian, stock exchange or investment advisor? *
yes no
Please describe briefly *
Have you, or a firm in which you were a senior officer, ever been convicted of a crime? *
yes no
Please describe briefly *
Did you hold a position in any governmental body for during the previous one year? *
yes no
Please describe briefly*
Do any of your immediate family members or close associates hold a position in any governmental body? *
yes no
Name *
Position *
Duration *
Did any of your immediate family members or close associates hold a position in any governmental body during the previous year? *
yes no
Name *
Position *
Duration *
II. Authorizations
Person(s) authorized to give us trade and transfer orders (if different from the account holder):
Name
Phone
E-mail:
Acting as authorized by (please attach duly executed evidence of authorization): *
ATTACH
Name
Phone
E-mail:
Acting as authorized by (please attach duly executed evidence of authorization): *
ATTACH
Is there any currently effective power of attorney or signatory authority granted to a person with U.S. legal/actual address?
yes no
III. Settlements and Account Information
Bank transfer instructions *
IV. Required KYC Documentation* for Individuals
  • Copy of the information page of your passport or other ID documents containing your photo and signature
  • Information from Bank on availability of the client’s Current cash account
  • Copy of the Georgian Taxpayer’s Certificate**
*Documents should be duly notarized and apostilled.
** If client doesn’t have Georgian Taxpayer’s ID, Galt & Taggart is required by Georgian Law to withhold from the client capital gain and other applicable taxes upon completion of transaction
Accept
SIGN AND SEND
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