Full Name:........................................................................................................................
Residential* or Business**Address:.....................................................................................
Billing Address (If different from Residential Address):..........................................................
Telephone:............................................................ Fax:.....................................................
E-mail: ..................................................................Web Site:.............................................
Bank references* (Name of bank, contact person, address, telephone, fax and email):
1.........................................................................................................................
2.........................................................................................................................
Commercial or Profesional references* (references only accepted from companies or professionals with whom you have a
business relationship)
1.........................................................................................................................
2.........................................................................................................................
Client's business background................................................................................
Origin of assets of fiduciary structure and related corporate vehicle:
..........................................................................................................................
Purpose of the fiduciary structure:........................................................................
Have you held or hold public position qualify you as political expouse person? (PEP):
Yes.... No....
If the previous answer is yes, indicating the position held:........................................
Fiduciary and Nominee Services
THE MORGAN & MORGAN GROUP REQUIRES TO RECEIVE THE SAME INFORMATION AND SUPPORTING DOCUMENTATION REGARDING THE CLIENT FROM
ALL THE PERSONS NAMED BELOW BEING ENEFICIARIES AND THE SETTLOR OR SETTLORS OF THE FIDUCIARY INSTRUMENT, ATTORNEY,
AUTHORISED PERSON, OR THE BENEFICIAL OWNER OF A CORPORATE INSTRUMENT WHERE NOT THE CLIENT OF EREFERENCE:
Name Settlor, Founder, Attorney, Authorised Country of Citizenship
Person, or Type of Beneficiary
1.
...................................... ................................................................... ..........................................
2. ...................................... ................................................................... ..........................................
3. ...................................... ................................................................... ..........................................
4. ...................................... ................................................................... ..........................................
5. ...................................... ................................................................... ..........................................
Intermediary or Corporate Clients Only
WE ARE AN INTERMEDIARY OR CORPORATE CLIENT AS DEFINED BY THE MORGAN & MORGAN GROUP, MMG TRUST, S.A. AND THEIR SUBSIDIARIES WHICH
ARE AUTHORISED TO RECEIVE AND EXECUTE INSTRUCTIONS ON OUR BEHALF FROM THE FOLLOWING CONTACT PERSONS:
Full Name Current Position in the Company Signature
1.
...................................... ................................................................... ..........................................
2. ...................................... ................................................................... ..........................................
3. ...................................... ................................................................... ..........................................
4. ...................................... ................................................................... .........................................
5. ...................................... ................................................................... ..........................................
THE MORGAN & MORGAN GROUP, MMG TRUST, S.A. AND THEIR SUBSIDIARIES RESERVE THE RIGHT TO REQUEST FROM THE ABOVE NAMED INDIVIDUALS THE
SAME INFORMATION AND SUPPORTING DOCUMENTATION REGARDING THE CLIENT IF SO REQUIRED IN COMPLIANCE WITH APPLICABLE STATUTORY AND
REGULATORY DUE DILIGENCE PROCEDURES.
Nature of business:
..........................................................................................................................
We are required to conduct a Due Diligence on our clients:
Yes.... No....
We are a regulated business:
Yes.... No....
Name of regulatory authority (IES) - If applicable:
1.........................................................................................................................
2.........................................................................................................................
List name of professional organizations of which you are a member:
1.........................................................................................................................
2.........................................................................................................................
WRITTEN TERMS OF BUSINESS FOR INTERMEDIARIES AND CORPORATE CLIENTS
IN ORDER TO COMPLY WITH GLOBAL DUE DILIGENCE STANDARDS, AS RECOMMENDED BY THE
FINANCIAL ACTION TASK FORCE (FATF), AND THE APPLICABLE LAWS OF PANAMA, BELIZE, THE
BRITISH VIRGIN ISLANDS, THE BAHAMAS, OR ANY OTHER JURISDICTION, WE, AS INTERMEDIARY OR
CORPORATE CLIENT IN RESPECT OF THE ORGANIZATION OF CORPORATIONS, TRUSTS OR
FOUNDATIONS, ON OUR INSTRUCTIONS, CERTIFY THE FOLLOWING:
1. WE HAVE PERFORMED ALL NECESSARY DUE DILIGENCE AND KNOW YOUR CLIENT
PROCEDURES REQUIRED BY LAW IN RESPECT OF OUR CLIENTS, AND WE KEEP OR WILL KEEP
RECORDS EVIDENCING ALL IDENTIFICATION PROCEDURES OF OUR CLIENTS AND RECORDS OF
ALL TRANSACTIONS FOR AT LEAST FIVE YEARS, FROM THE DATE OF TERMINATION OR
DEEMED TERMINATION OF BUSINESS WITH OUR CLIENTS.
2. WE UNDERTAKE TO ADVISE YOU OF EVERY CASE IN WHICH IT HAS NOT BEEN OR IS NOT
POSSIBLE TO VERIFY THE IDENTITY OF THE APPLICANT FOR A CORPORATION, TRUST OR
FOUNDATION.
3. WE ACCEPT TO SUPPLY YOU IMMEDIATELY WITH EVIDENCE OF THE VERIFICATION OF THE
IDENTITY OF OUR CLIENTS IN ANY APPROPRIATE MATTER AFFECTED BY THE ANTI-MONEY
LAUNDERING OR TERRORISM FINANCING LAWS OF THE JURISDICTIONS OF PANAMA, BELIZE,
THE BRITISH VIRGIN ISLAND, THE BAHAMAS, OR ANY OTHER JURISDICTION. IN PARTICULAR IN
ANY MATTER WHERE YOU ARE REQUIRED TO ASSIST THE AUTHORITIES WITH INQUIRIES BEING
MADE IN RELATION TO MONEY LAUNDERING OR TERRORISM FINANCING LAWS ACTIVITIES OR
RELATED OFFENCES.
4. WE CONFIRM THAT IN THE CASE BEARER SHARES ARE ASSIGNED TO NEW SHAREHOLDERS,
THE DUE DILIGENCE AND KNOW-YOUR-CLIENT PROCEDURES WILL ALSO BE PERFORMED.
5. WE FURTHER CONFIRM THAT SHOULD ANY OF OUR CLIENTS REQUEST THAT A GENERAL
POWER OF ATTORNEY IS ISSUED IN FAVOR OF A PERSON ON WHOM WE HAVE NOT DONE THE
APPROPRIATE DUE DILIGENCE AND KNOW-YOUR-CLIENT PROCEDURES, THAT THESE WILL BE
PERFORMED IN THE SAME MANNER AS STATED ABOVE.
6. WE UNDERSTAND THAT YOU CANNOT ORGANIZE A CORPORATION, TRUST OR FOUNDATION,
OR CONTINUE TO PROVIDE REGISTERED AGENT SERVICES FOR COMPANIES ALREADY
FORMED, IF WE ARE UNABLE TO COMPLY WITH ANY OF THE FOREGOING UNDERTAKINGS.
7. WE ARE DIRECTLY RESPONSIBLE FOR THE PAYMENT OF THE INVOICES RELATED TO THE
SERVICES OR INSTRUMENTS REQUESTED AS WELL AS FOR THE PAYMENT OF THE ANNUITIES
ACTUALLY COLLECTED ON BEHALF OF MORGAN & MORGAN GROUP. WE UNDERSTAND THAT
MORGAN & MORGAN GROUP RESERVES THE RIGHT AT ITS SOLE AND ENTIRE DISCRETION TO
TERMINATE THE RELATION WITH ANY CLIENT THAT DEFAULTS THE TERMS SET FORTH IN THE
CORRESPONDING INVOICES.
8. WE FURTHER CERTIFY THAT IF FOR ANY REASON WE TERMINATE BUSINESS WITH OUR SAID
CLIENTS, WE SHALL INFORM YOU IMMEDIATELY THE REASONS FOR THAT TERMINATION, IN
THE UNDERSTANDING THAT YOU WILL DECIDE IF YOU SHOULD CONTINUE TO PROVIDE THE
SERVICES HIRED DIRECTLY TO THE CLIENT.
MORGAN & MORGAN GROUP, THROUGH ITS FIDUCIARY & TRUST SERVICES UNIT, HEREBY AGREES TO ENTER INTO A PROFESSIONAL
RELATIONSHIP FOR SERVICES WITH THE CLIENT REPRESENTED BY THE UNDERSIGNED, WHO UNDER OATH MAKES THE FOLLOWING
STATEMENTS:
1. THE UNDERSIGNED SHALL BE THE LEGAL REPRESENTATIVE OF THE CLIENT (HEREINAFTER "THE CLIENT") BEFORE MORGAN & MORGAN
GROUP FROM WHOM IT WILL RECEIVE NOTICES AND TO WHOM IT SHALL GIVE INSTRUCTIONS FOR WHICH HE/SHE UNDERTAKES FULL
RESPONSIBILITY, AS WELL AS FOR ANY PROFESSIONAL FEES CAUSED AND EXPENSES INCURRED BY MORGAN & MORGAN GROUP BY
VIRTUE OF THE SERVICE REQUESTED OR FOR ANY OTHER ASSIGNMENT OR SERVICE THAT I AS CLIENT MAY REQUEST IN THE FUTURE.
2. IN MY CONDITION AS CLIENT, I UNDERTAKE TO INFORM MORGAN & MORGAN GROUP OF ANY CHANGE IN THE INFORMATION DISCLOSED AS
IT HAPPENS.
3. IN MY CONDITION AS CLIENT, I HEREBY DECLARE THAT THE CORPORATE OR FIDUCIARY STRUCTURES INCLUDING ITS RELATED
COMPANIES, WILL NOT ENGAGE IN BUSINESS WITH ANY COUNTRY, PERSON OR ACTIVITY LISTED BY THE U.S. TREASURY'S OFFICE OF
FOREIGN ASSETS CONTROL (OFAC) http://www.ustreas.gov/offices/enforcement/ofac/ AND THAT NONE OF THE ASSETS THAT MAY BE
TRANSFERRED DERIVED OR ARE RELATED TO ILLEGAL ACTIVITIES INCLUDING, BUT WITHOUT LIMITATION, THE PURCHASE, SALE,
TRANSPORTATION OR USE OF ILLEGAL SUBSTANCES OR ACTIVITIES THAT PURSUANT TO THE CURRENT LAW OF THE REPUBLIC OF
PANAMA CONSTITUTE CRIMES OF MONEY LAUNDERING OR FINANCING OF TERRORISM UNDER SUCH LAWS.
4. IN MY CONDITION AS CLIENT, I HEREBY DECLARE THAT THE ORIGIN OF THE ASSETS RELATING TO THE SERVICES REQUESTED AND
DEPOSITED UNDER THE CONTROL OF MORGAN & MORGAN GROUP IS THE ONE LISTED IN PAGE 2 OF THIS DOCUMENT.
5. IN MY CAPACITY AS CLIENT, I AM AWARE OF THAT THERE IS NO PROFESSIONAL PRIVILEGE OF SECRECY IN CRIMINAL CASES RELATING
TO MONEY LAUNDERING, THE FINANCING OF TERRORISM AND OTHER CRIMES AGAINST HUMANITY.
6. I HEREBY DECLARE AND WARRANT THAT:
- I HAVE RECEIVED RELEVANT ADVICE FROM A LAWYER AND/OR ACCOUNTANT REGARDING MY LEGAL/FISCAL RESPONSIBILITIES UNDER
LAWS OF THE COUNTRY OR COUNTRIES OF WHICH I AM A CITIZEN, RESIDENT OR WHERE THE FIDUCIARY OR CORPORATE INSTRUMENT
OPERATES, IN RELATION TO THE SERVICES THAT I REQUEST FROM MORGAN & MORGAN GROUP, ITS SUBSIDIARIES AND FILIATES.
- I HEREBY, HOLD HARMLESS AND AGREE TO INDEMNIFY MORGAN & MORGAN GROUP, ITS SUBSIDIARIES, AFFILIATES, PARTNERS, AND
EMPLOYEES FROM ANY RESPONSIBILITY OR LIABILITY OF ANY KIND ARISING FROM THE LEGAL, FIDUCIARY, FINANCIAL, CORPORATE AND
FURTHER SERVICES RENDERED, INCLUDING COURT COSTS AND EXPENSES TO DEFEND ANY LEGAL ACTION STARTED BY THIRD PARTIES
BY REASON OF ANY ACT OR OMISSION BY MORGAN & MORGAN GROUP, ITS SUBSIDIARIES AND FILIATES AS A CONSEQUENCE OF MY
VERBAL OR WRITTEN INSTRUCTIONS.
- I HEREBY AUTHORIZE MORGAN & MORGAN GROUP TO DISCLOSE ANY INFORMATION GIVEN TO THEM OR TO ANY OF ITS EMPLOYEES IF SO
REQUESTED BY A COMPETENT AUTHORITY OF THE COUNTRY OR COUNTRIES OF WHICH I AM A CITIZEN OR RESIDENT, OR WHERE THE
FIDUCIARY OR CORPORATE INSTRUMENT OPERATES, WHEN DEMANDED THROUGH PROPER INTERNATIONAL LEGAL CHANNELS AND WHEN
SO ACCEPTED BY COMPETENT JUDICIAL AUTHORITY WITH DIRECT JURISDICTION OVER ANY OFFICE OF MORGAN & MORGAN GROUP, ITS
SUBSIDIARIES OR AFFILIATES TO WHICH SUCH REQUEST IS PRESENTED, AND WHICH OFFICE I LIKEWISE RELEASE FROM ANY
RESPONSIBILITY FOR DISCLOSING THE SAME, BEING UNDERSTOOD THAT MORGAN & MORGAN GROUP AGREES TO OPPOSE TO THE
MAXIMUM EXTENT ALLOWED BY APPLICABLE LAWS, ANY REQUEST FOR INFORMATION IF THEY CONSIDER THAT THE MERITS OF THE
REQUEST ARE SUCH THAT SUCH ACTION IS JUSTIFIED, IN WHICH CASE THE FEES AND EXPENSES CAUSED BY THEM SHALL BE ASSUMED
BY THE CLIENT.
- I HEREBY AUTHORIZE MORGAN & MORGAN TO COMMUNICATE WITH MYSELF TO BE BY ANY TELEPHONE AND OTHER ELECTRONIC MEANS
AVAILABLE INCLUDING E-MAIL. WITH REGARDS TO E-MAILS, I HEREBY ACKNOWLEDGE THAT THESE ARE NOT PROTECTED BY FIDUCIARY/
ATTORNEY/BANK-CLIENT PRIVILEGE, AND THEREFORE RELEASE MORGAN & MORGAN GROUP OF ANY RESPONSIBILITY FOR LEAKS OF
INFORMATION OCCURING BY THE US OF SUCH MEANS NOT ATTRIBUTABLE TO WILFUL ACTS BY THE LAWYERS, EXECUTIVES OR
EMPLOYEES OF MORGAN & MORGAN GROUP.
THE FOREGOING STATEMENTS ARE THE TERMS ON WHICH THE MORGAN & MORGAN GROUP AGREES TO PROVIDE SERVICES TO THE CLIENT.
ANY FAULT IN THOSE STATEMENTS MAY BE CAUSE FOR TERMINATION OF OUR SERVICES. IN ORDER TO ESTABLISH A PROFESSIONAL
RELATIONSHIP BETWEEN THE CLIENT AND OUR COMPANY, IT IS NECESSARY TO COMPLY WITH OUR DUE DILIGENCE AND KNOW YOUR
CLIENT PROCEDURES AS SET FORTH IN THIS DOCUMENT, WHICH OUGHT TO BE COMPLETED, SIGNED AND RETURNED TO US IN ONE
ORIGINAL TOGETHER WITH THE APPLICABLE DOCUMENTS LISTED THEREIN AND OTHERS THAT, AT THE DISCRETION OF MORGAN & MORGAN
MAY BE REQUIRED TO SUCH ENDS. FAILURE TO FULFILL ANY OF THESE REQUIREMENTS MAY DELAY OR CAUSE US TO DECLINE PROVIDING
SERVICES.
I CONFIRM THAT I HAVE READ, UNDERSTOOD AND ACCEPTED THE AGREEMENT AND/OR THE GLOBAL TERMS OF BUSINESS AS
APPLICABLE TO ME.
Name and Occupation: Date and Signature:
...................................... ........................................................
country of Citizenship: Passport #:.
...................................... ........................................................
CHECK LIST OF DOCUMENTS TO BE SUBMITTED
....Client information and Service Agreement form duly completed and signed.
....Notarized copy of the unexpired passport of the person signing the client information form and persons listed at
pages 2 and 3 as applicable
....Copy of a utility bill or bank statement not older than three months confirming the physical address for the client of
reference
....At least two bank references or one bank reference plus one commercial or professional references not older than
three months
....Board authorization to act on behalf of the company (intermediary and corporate clients only)
....Memorandum of Association (intermediary and corporate clients only)
....Certificate of Good Standing (intermediary and corporate clients only)
....Company brochure, website and description of business activities (intermediary and corporate clients only)
Please return this form completed and signed as necessary together with all requested supporting
documents as follows:
a) In a sealed envelope to: Private & Confidential - Due Diligence
MMG TRUST, S.A.
MMG Tower, 8th Floor
53rd Street, Urb. Marbella
P.O. Box 0823-01358 Plaza Concordia
Panama, Rep. of Panama
(b) Copy of this application and of the supporting documents can be sent in advance, for verification purposes only, by email
or fax to:
By fax to: Compliance Officer
(507) 265-7643
By e-mail to: compliance@mmgtrust.com
OFFICE USE ONLY
Location: Date:
Received by:.................. ................................................................... ..................
Reviewing .................. ................................................................... ..................
Compliance Officer
R.L. :.................. ................................................................... ..................
