How to Order - Open a Swiss Bank Account

Title:
First Name:
Last Name:
Date of Birth:
Natonality:

Residence Address:

Street/Number:
Postal Code:
City:
Country:

Correspondence address, only if your correspondence address is different:

Street/Number:
Postal Code:
City:
Country:

Contact Details:

E-mail:
Day Phone Number:
Mobile Phone Number:
Alternative Phone Number:
Fax Number:

Other personal information:

Occupation:
Company:
Language:
Marital Status:
Planned Investment:

Origin of money to invest (Select as many as apply, min. 1 choice)

Are you a politically exposed person?

If yes, which one

Identification of the beneficial owner: Tick only One

	I declare that I am the beneficial owner of the assets deposited with the bank.

	I declare that the beneficial owner of the assets deposited with the Bank is: (please fill in the form below)

Title:
First Name:
Last Name:
Date of Birth:
Natonality:
Street/Number:
Postal Code:
City:
Country:


	I undertake to inform the Bank spontaneously of any changes.Wilfully entering false information in this form is a criminal offense(art. 251 of the Swiss Penal Code, forgery of documents; under penalty or penal servitude of up to five years or a prison sentence). *failure to tick on this box will result in your order not being processed.


Declaration of non-US tax liability: Tick only One

	I declare that I am not a US citizen and that I am not a resident ofthe US and that I do not have a permanent US residence visa and that I am not liable to taxation in the US for any other reason.

	II declare that I am a US citizen or that I am a resident of the US or that I have a permanent US residence visa or that I am liable to taxation in the US for any other reason. In this event, I acknowledge and accept that, for legal and tax reasons, the bank cannot offer me access to stock markets in the United States, to US securities listed on other markets or to investment funds traded via its trading platform.

1. Fill in this form.
2. We'll e-mail you to give you the instructions as to how to make the
 payment for our intermediary services. Our fee is just 49.99€ and 
 can be transferred via Western Union from all over the world.
3. Upon confirmation that the payment has been made, we'll submit the
 application to the bank. The relationship between you, the customer,
 and us, the service provider, ends there and then. Be sure you have a
 notarized photocopy of your passport (it does not need to be
 apostilled) and a recent utility bill as proof of domicile. The bank
 will contact you and will ask you these documents in order to open the
 account. You will thenceforth handle personally all banking matters by
 addressing directly the bank.

Note: if for any reason the bank refuses to open the account 
you will receive a full refund.

Personal Information: