Corporate Client (Fill one per client)
 
 I hereby declare that I am or will be the beneficial owner of shares in the company named below an d that the following information correct and true:
       
   
 
We hereby declare that we are or will be the beneficial owner (the "Corporate Client") of
 
shares in
   
  Name of Corporate Client  
  Address of principal place of business (in full)  
       
  CONTACT CLIENT (beneficial owner)    
  Phone No.
  
  Phone No. (other)
  
  Fax  
  Email  
  Mailing address
(if different from above)		  
  Name & office of authorized
representative: 		 
       
 

Please note that the following must be enclosed with this form
 
  1. Copy of certificate of incorporation
  2. 2 references as to reputation and standing from:
   
 
  We hereby authorize you to independently verify any information provided herein and undertake to inform you of any changes to the above as soon as reasonably possible.  
       
  For and on behalf of the Corporate Client:
  Client signature  
  Date  
       
 
Click for Guidance Notes

Guidance Notes (Corporate client)

The Client Profile form should be completed in respect of every beneficial owner. The supporting documents, namely the certified copy of the Certificate of Incorporation and the two references, which are required in respect of the beneficial owner, must be returned to us with this form.

With regard to the references, they may consist of one as to reputation and standing of the Corporate Client (beneficial owner) and the other may be a financial reference:

1. If a reference as to reputation and standing only:

  1. the reference should be current, from a professional (e.g. Lawyer, accountant, doctor or banker) and should be presented on original letterhead.
  2. The referee should have had regular dealings with the client for a minimum of 3 years. The actual number of years must be stated.
  3. The referee should outline what he knows of the business and history of the client.
  4. The reference must be addressed to the Compliance Officer, C.F. Butler & Associates P.O. Box N-1462 Nassau, Bahamas.
       
   
   
 
 
 
 
 
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