Client information & FICA - Reenen van Reenen Inc.

Client information
& FICA

Step 1 of 17

Our request for information and documentation, which we require in terms of the Financial Intelligence Act, are detailed hereafter. We realise that some questions may appear intrusive, and that this is inconvenient, but in terms of this legislation, we as a Legal Practitioners, are appointed as an Accountable Institution, and thus obliged, to confirm certain information, and to verify it. Failure to do this will make us guilty of a criminal offence whereby fines of up to R50 million can be imposed. We may also not transact with you unless we comply with the legislation. As such we request your cooperation in completing the attached and providing us with copies of all supporting documentation referred to.

I Accept

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Entity

Select the entity type that applies to you(Required)

Individuals Details

Name(Required)

First Last

Date of Birth

DD slash MM slash YYYY

Identity/Passport Number(Required)

Upload Identity/Passport Document(Required)

Max. file size: 128 MB.

Nationality(Required)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Postal address same as above?(Required)

Yes

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Upload Proof of Address(Required)

Max. file size: 128 MB.

- Most recent utility bill (NOT mobile telephone bills, bills printed from the internet, statements of account or general correspondence); or - Current (within the last 3 months) bank statement; or - Document issued by SARS, such as PAYE notices and statements of account (NOT employer-issued documents).

Upload Proof of Postal Address(Required)

Max. file size: 128 MB.

Work Telephone Number(Required)

Cell Phone(Required)

Email(Required)

Income Tax Number(Required)

Upload Proof of Income Tax Number(Required)

Max. file size: 128 MB.

Marital Status(Required)

Not Married

Married in community of property

Married out of community of property

Married according to customary law

Other

Upload Marriage Certificate

Max. file size: 128 MB.

Upload Ante-nuptial Contract (If applicable)

Max. file size: 128 MB.

Contact person if unreachable(Required)

First Last

Relationship with contact(Required)

Work Telephone Number(Required)

Cell Phone Number(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Deceased Estate

Deceased Full Name(Required)

First Last

Deceased Identity/ Passport number(Required)

Upload Identity/Passport Document for Deceased(Required)

Max. file size: 128 MB.

Upload Death Certificate of Deceased(Required)

Max. file size: 128 MB.

Upload Deceased’s Last Will and Testament(Required)

Max. file size: 128 MB.

Physical Address Before Deceased(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Upload Proof of Address for Deceased(Required)

Max. file size: 128 MB.

We will only accept the following proofs of address: - Most recent utility bill (NOT mobile telephone bills, bills printed from the internet, statements of account or general correspondence); or - Current (within the last 3 months) bank statement; or - Document issued by SARS, such as PAYE notices and statements of account (NOT employer-issued documents).

Is the postal address for the deceased same as above?(Required)

Yes

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Upload proof of postal address of the deceased(Required)

Max. file size: 128 MB.

MARITAL STATUS OF THE DECEASED(Required)

Not married

Married in community of property

Married out of community of property

Married according to customary law

Other

Upload Marriage Certificate for Deceased

Max. file size: 128 MB.

Upload Ante-nuptial Contract for Deceased (If Applicable)

Max. file size: 128 MB.

Income Tax Number of Deceased(Required)

Upload Proof of Income Tax Number for Deceased(Required)

Max. file size: 128 MB.

Banking Details of Deceased

Account Holder Name(Required)

Bank(Required)

Account Number(Required)

Branch Code(Required)

Upload Proof of banking details (bank-stamped account confirmation letter) for Deceased(Required)

Max. file size: 128 MB.

Organisation details

Name of Company(Required)

Business Name(Required)

Name of Close Corporation(Required)

Name of Partnership(Required)

Name of Joint Venture(Required)

Any other name the joint venture uses (trading as) if different from above:(Required)

Nature of commencement of joint venture:(Required)

Any other name the partnership uses (trading as) if different from above:(Required)

Name of Body Corporate(Required)

Name of Non-profit Organisation(Required)

Name of Trust(Required)

Trust IT Number(Required)

Registration Number(Required)

Any other name the company uses (trading as) if different from above(Required)

Nature of the business(Required)

Any other name the body corporate uses (trading as) if different from above(Required)

Date of incorporation(Required)

DD slash MM slash YYYY

Date of Commencement of Trade(Required)

DD slash MM slash YYYY

Date of Commencement of Joint Venture(Required)

DD slash MM slash YYYY

Upload Joint Venture Agreement(Required)

Max. file size: 128 MB.

Upload Partnership Agreement(Required)

Max. file size: 128 MB.

Upload Copy of Trust Deed(Required)

Max. file size: 128 MB.

Upload Certificate of Incorporation (CM1/COR14.1)(Required)

Max. file size: 128 MB.

Upload copy of certificate of registration as non-profit organisation(Required)

Max. file size: 128 MB.

Upload proof founding statement (CK1)(Required)

Max. file size: 128 MB.

Upload proof of mended founding statement (if applicable)(CK2)(Required)

Max. file size: 128 MB.

Upload Proof of official Company Documents(Required)

Drop files here or

Max. file size: 128 MB.

Upload Proof of securities and exchange list(Required)

Drop files here or

Max. file size: 128 MB.

Upload Proof Of Certificate of Incorporation (An official document issued by an authority recording the incorporating companies in that country)(Required)

Max. file size: 128 MB.

Upload Certificate to Commence Business (CM46/COR14.3)(Required)

Max. file size: 128 MB.

Upload Certificate to Commence Business(Required)

Max. file size: 128 MB.

Upload Certificate of Registration(Required)

Max. file size: 128 MB.

Upload Register of Directors, Auditors and Officers(Required)

Max. file size: 128 MB.

Upload proof of trading name(Required)

Max. file size: 128 MB.

Upload Register of Directors, Auditors and Officers(CM29/COR39)(Required)

Max. file size: 128 MB.

Registered Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Main Place of Business Address Same as Above(Required)

Yes

Main Place of Business Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Postal Address Same as Above(Required)

Yes

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Upload Notice of registered office address of company (CM22/COR21.1)(Required)

Max. file size: 128 MB.

Upload Proof Of Address(Required)

Max. file size: 128 MB.

Upload Proof Of Postal Address(Required)

Max. file size: 128 MB.

TAX DETAILS

Please fill in the tax details of the organisation

Income Tax Number(Required)

VAT Registration Number

VAT registration number (if applicable):

VAT Registration number certificate(If applicable)

Max. file size: 128 MB.

Upload Proof of Income Tax Number(Required)

Max. file size: 128 MB.

Details of Executor/ Executrix

Executor/Executrix Name(Required)

First Last

Executor/Executrix cell phone number(Required)

Executor/Executrix Work Telephone Number(Required)

Executor/Executrix Email Address(Required)

Executor/Executrix Income Tax Number(Required)

Executor/Executrix Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Executor/Executrix Postal Address same as Physical Address?(Required)

Yes

Executor/Executrix Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Upload Proof of Address for Executor/Executrix(Required)

Max. file size: 128 MB.

We will only accept the following proofs of address -Most recent utility bill (NOT mobile telephone bills, bills printed from the internet, statements of account or general correspondence); or - Current (within the last 3 months) bank statement; or - Document issued by SARS, such as PAYE notices and statements of account (NOT employer- issued documents).

Upload Identity/Passport Document for Executor/Executrix(Required)

Max. file size: 128 MB.

Upload Letters of Executorship(Required)

Max. file size: 128 MB.

Banking Details

Account holder name(Required)

Account Number(Required)

Bank(Required)

Branch Code(Required)

Upload Proof of Banking Details (bank-stamped account confirmation letter) for Executor/Executrix(Required)

Max. file size: 128 MB.

Banking Details

Please fill in the banking details of you or your organisation below

Account holder name(Required)

Account Number(Required)

Bank(Required)

Branch Code(Required)

Upload Proof of Banking Details (bank stamped account confirmation letter)(Required)

Max. file size: 128 MB.

Director Details

Name of Director(Required)

First Last

Identity/passport number:(Required)

Work telephone number:(Required)

Cell phone number:(Required)

Email(Required)

Upload Copy Of Identity/Passport Document(Required)

Max. file size: 128 MB.

Does the director have authority to act on behalf of the company?(Required)

Yes

Upload Resolution passed by directors authorising person(s) to act on behalf of the company(Required)

Max. file size: 128 MB.

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:(Required)

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Add another director?(Required)

Yes

Director 2

Name of Director(Required)

First Last

Identity/passport number of director:(Required)

Work Telephone Number(Required)

Cell Phone(Required)

Email(Required)

Upload Copy Of Identity/Passport Document(Required)

Max. file size: 128 MB.

Does the director have authority to act on behalf of the company?(Required)

Yes

Upload Resolution passed by directors authorising person(s) to act on behalf of the company(Required)

Max. file size: 128 MB.

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:(Required)

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Add another director?(Required)

Yes

Director 3

Name of Director

First Last

Upload Copy Of Identity/Passport Document

Work Telephone Number

Cell phone number:

Upload Copy Of Identity/Passport Document

Max. file size: 128 MB.

Does the director have authority to act on behalf of the company?(Required)

Yes

Upload Resolution passed by directors authorising person(s) to act on behalf of the company

Max. file size: 128 MB.

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Add another director?(Required)

Yes

Director 4

Name of Director

First Last

Upload Copy Of Identity/Passport Document

Cell phone number:

Work Telephone Number

Upload Copy Of Identity/Passport Document

Max. file size: 128 MB.

Does the director have authority to act on behalf of the company?(Required)

Yes

Upload Resolution passed by directors authorising person(s) to act on behalf of the company

Max. file size: 128 MB.

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Add another director?(Required)

Yes

Director 5

Name of Director

First Last

Upload Copy Of Identity/Passport Document

Cell phone number:

Work Telephone Number

Upload Copy Of Identity/Passport Document

Max. file size: 128 MB.

Does the director have authority to act on behalf of the company?(Required)

Yes

Upload Resolution passed by directors authorising person(s) to act on behalf of the company

Max. file size: 128 MB.

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Members

Name of Member(Required)

First Last

Identity / Passport Number of Member(Required)

Date of birth(Required)

DD slash MM slash YYYY

Nationality(Required)

Upload identity/ passport document(Required)

Max. file size: 128 MB.

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Upload Proof of Physical Address(Required)

Max. file size: 128 MB.

Most recent utility bill (NOT mobile telephone bills, bills printed from the internet, statements of account or general correspondence); or - Current (within the last 3 months) bank statement; or - Document issued by SARS, such as PAYE notices and statements of account (NOT employer-issued documents).

Work Telephone Number(Required)

Cell Phone(Required)

Email(Required)

Income Tax Number(Required)

Proof of Income Tax Number(Required)

Max. file size: 128 MB.

Banking Details

Account Holder Name(Required)

Account Number(Required)

Account Holder Name Branch Code

Bank(Required)

Branch Code(Required)

Upload proof of banking details (bank-stamped account confirmation letter)(Required)

Max. file size: 128 MB.

Marital Status of member(Required)

Not Married

Married in community

Married out of community

Married according to customary law

Other

Upload Marriage Certificate

Max. file size: 128 MB.

Upload Ante-nuptial contract

Max. file size: 128 MB.

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:(Required)

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Contact Person If Unreachable(Required)

First Last

Relationship with contact(Required)

Cell Phone Number(Required)

Email(Required)

Physcial Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Does this member have authority to act on behalf of the organisation?(Required)

Yes

Upload Resolution passed by members authorising persons to act on behalf of close corporation(Required)

Max. file size: 128 MB.

Upload Resolution passed by members authorising persons to act on behalf of the body corporate(Required)

Max. file size: 128 MB.

Add another member?(Required)

Yes

Member 2

Name of Member

First Last

Identity / Passport Number of Member

Date of Birth

DD slash MM slash YYYY

Nationality

Upload identity/ passport document

Max. file size: 128 MB.

Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Upload Proof of Physical address

Max. file size: 128 MB.

Work Telephone Number

Cell Phone

Income Tax Number

Proof of income tax number(Required)

Max. file size: 128 MB.

Bank Account Details

Marital Status of member

Not Married

Married in community

Married out of community

Married according to customary law

Other

Does this member have authority to act on behalf of organisation(Required)

Yes

Upload Resolution passed by members authorising persons to act on behalf of close corporation

Max. file size: 128 MB.

Upload Resolution passed by members authorising persons to act on behalf of the body corporate

Max. file size: 128 MB.

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Contact Person If Unreachable

First Last

Cell Phone

Relationship with contact

Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add another member?(Required)

Yes

Add Member 3

Name of Member

First Last

Identity/ Passport Number of Member

Date of birth

DD slash MM slash YYYY

Nationality

Upload identity/ passport document Copy

Max. file size: 128 MB.

Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Upload proof of physical address

Max. file size: 128 MB.

Work Telephone Number

Cell Phone

Income Tax Number

Upload proof of income tax number(Required)

Max. file size: 128 MB.

Bank Account Details

Proof of banking

Max. file size: 128 MB.

Marital Status of member

Not Married

Married in community

Married out of community

Married according to customary law

Other

Upload Marriage Certificate

Max. file size: 128 MB.

Upload Ante-Nuptial Contact

Max. file size: 128 MB.

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Does this member have authority to act on behalf of organisation(Required)

Yes

Upload Resolution passed by members authorising persons to act on behalf of close corporation

Max. file size: 128 MB.

Upload Resolution passed by members authorising persons to act on behalf of body corporate

Max. file size: 128 MB.

Contact Person If Unreachable

First Last

Phone

Relationship with contact

Cell Phone

Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add another member?

Yes

Member 4

Name of Member

First Last

Identity/ Passport Number of Member

Date of birth

DD slash MM slash YYYY

Nationality

Upload Identity/ Passport Document

Max. file size: 128 MB.

Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Upload proof of physical address

Max. file size: 128 MB.

Work Telephone Number

Cell Phone

Income Tax Number

Proof of Income Tax Number(Required)

Max. file size: 128 MB.

Bank Account Details

Proof of banking

Max. file size: 128 MB.

Marital Status of member

Not Married

Married in community

Married out of community

Married according to customary law

Other

Upload Marriage Certificate

Max. file size: 128 MB.

Upload Ante-nuptial contract

Max. file size: 128 MB.

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Does this member have authority to act on behalf of organisation

Yes

Upload Resolution passed by members authorising persons to act on behalf of close corporation

Max. file size: 128 MB.

Upload Resolution passed by members authorising persons to act on behalf of body corporation

Max. file size: 128 MB.

Contact Person If Unreachable

First Last

Relationship with contact

Cell Phone

Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add another member?

Yes

Member 5

Name of Member

First Last

Identity/ Passport Number of Member

Date of birth

DD slash MM slash YYYY

Nationality

Upload identity/ passport document

Max. file size: 128 MB.

Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Upload proof of physical address

Max. file size: 128 MB.

Work Telephone Number

Cell Phone

Income Tax Number

Proof of income tax number(Required)

Max. file size: 128 MB.

Bank Account Details

Upload proof of address

Max. file size: 128 MB.

Marital Status of member

Not Married

Married in community

Married out of community

Married according to customary law

Other

Upload Marriage Certificate

Max. file size: 128 MB.

Upload Ante-nuptial contract

Max. file size: 128 MB.

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Does this member have authority to act on behalf of organisation

Yes

Upload Resolution passed by members authorising persons to act on behalf of close corporation

Max. file size: 128 MB.

Upload Resolution passed by members authorising persons to act on behalf of body corporation

Max. file size: 128 MB.

Contact Person If Unreachable

First Last

Phone

Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Founder

Name(Required)

First Last

Identity/ passport number of founder(Required)

Upload identity/ passport document(Required)

Max. file size: 128 MB.

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:(Required)

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Contact Person if Unreachable

First Last

Cell Phone

Relationship to contact

Trustees

Name of trustee(Required)

First Last

Identity/Passport Number of Trustee(Required)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Postal Address Same as above?

Yes

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Telephone Number(Required)

Cell Phone Number(Required)

Email(Required)

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:(Required)

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Banking Details

Account Holder Name

Account Number

Bank

Branch Code

Contact person if unreachable

Name

First Last

Relationship to contact

Cell Phone

Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add another trustee?(Required)

Yes

Trustee 2

Name of Trustee(Required)

First Last

Identity/Passport Number of Trustee(Required)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Physical Address same as postal?(Required)

Yes

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Telephone Number(Required)

Cell Phone Number(Required)

Email(Required)

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:(Required)

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Banking details

Account Holder Name

Account Number

Bank

Branch Code

Name

First Last

Relationship to contact

Cell Phone

Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add another trustee?(Required)

Yes

Trustee 3

Name of trustee(Required)

First Last

Identity/Passport Number of Trustee(Required)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Physical Address same as postal?(Required)

Yes

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Telephone Number(Required)

Cell Phone Number(Required)

Email(Required)

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:(Required)

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Banking details

Account Holder Name

Account Number

Bank

Branch Code

Contact Person if unreachable

Name

First Last

Relationship to contact

Cell Phone

Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add another trustee?(Required)

Yes

Trustee 4

Name(Required)

First Last

Identity/Passport Number of Trustee(Required)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Postal address same as physical?(Required)

Yes

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work telephone number(Required)

Cell phone number(Required)

Email(Required)

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:(Required)

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Banking Details

Account Holder Name

Account Number

Bank

Branch Code

Contact Person if Unreachable

Name

First Last

Relationship to contact

Cell Phone

Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add another trustee?(Required)

Yes

Trustee 5

Name(Required)

First Last

ID Number/ Passport Number of Trustee(Required)

Untitled

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Postal Address same as physical?(Required)

Yes

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Telephone Number(Required)

Cell phone Number(Required)

Email(Required)

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:(Required)

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Banking Details

Account Holder Name

Account Number

Bank

Branch Code

Contact person if unreachable

Name

First Last

Relationship to contact

Cell Phone

Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Details of Partners

Name(Required)

First Last

Identity/ Passport Number of Partner(Required)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is postal same above?

Yes

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Telephone Number(Required)

Cell Phone Number(Required)

Email(Required)

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:(Required)

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Contact Person if Unreachable

First Last

Cell Phone Number

Relationship to contact

Add another partner?(Required)

Yes

Partner 2

Name of partner(Required)

First Last

Identity/ Passport number of Partner(Required)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is postal address same as above?(Required)

Yes

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Telephone Number(Required)

Cell Phone(Required)

Email(Required)

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:(Required)

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Add another partner?(Required)

Yes

Contact Person If Unreachable

First Last

Cell Phone

Relationship to contact

Partner 3

Name(Required)

First Last

Identity/ Passport Number of Partner(Required)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is postal address same as above?(Required)

Yes

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Telephone Number(Required)

Cell Phone Number(Required)

Email(Required)

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:(Required)

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Contact Person If Unreachable

First Last

Cell Phone

Relationship to contact

Add another partner?(Required)

Yes

Partner 4

Name of partner(Required)

First Last

Identity/Passport Number of Partner(Required)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is postal address same as above?(Required)

Yes

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Telephone Number(Required)

Cell Phone Number(Required)

Email(Required)

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:(Required)

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Contact person if uncreachable

First Last

Cell Phone

Relationship to contact

Add another partner?(Required)

Yes

Partner 5

Name of partner(Required)

First Last

Idenitity/Passport Number of partner(Required)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is postal address same as above?(Required)

Yes

Name

First Last

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Telephone Number(Required)

Cell Phone Number(Required)

Email(Required)

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:(Required)

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Name

First Last

Cell Phone

Relationship to contact

Details of Shareholder(s)

Only enter shareholders with 25% or more voting right

Name of Shareholder(Required)

First Last

ID Number/ Passport Number of Shareholder(Required)

Percentage(Required)

Upload ID of shareholder with 25% or more voting right(Required)

Max. file size: 128 MB.

Add another shareholder?(Required)

Yes

Shareholder 2

Name(Required)

First Last

ID Number/ Passport Number of Shareholder(Required)

Percentage(Required)

Upload ID of shareholder with 25% or more voting right(Required)

Max. file size: 128 MB.

Add another shareholder?(Required)

Yes

Shareholder 3

Name(Required)

First Last

ID Number/ Passport Number of Shareholder(Required)

Percentage(Required)

Upload ID of shareholder with 25% or more voting right(Required)

Max. file size: 128 MB.

Add another shareholder?(Required)

Yes

Shareholder 4

Name(Required)

First Last

ID Number/ Passport Number of Shareholder(Required)

Percentage(Required)

Upload ID of shareholder with 25% or more voting right(Required)

Max. file size: 128 MB.

Beneficial Owner(s)

Name of beneficial owner(Required)

First Last

ID Number/ Passport Number of Beneficial Owner(Required)

Date of birth(Required)

DD slash MM slash YYYY

Nationality(Required)

Upload Copy Of Identity/Passport Document(Required)

Max. file size: 128 MB.

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Upload Proof of Physical Address(Required)

Max. file size: 128 MB.

Postal Address same as above?(Required)

Yes

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Upload Proof of Postal Address(Required)

Max. file size: 128 MB.

Work Telephone Number(Required)

Cell Phone(Required)

Email(Required)

Tax Details

Income Tax Number(Required)

Proof Of Income Tax Number(Required)

Max. file size: 128 MB.

Banking Details

Account Holder Name(Required)

Account Number(Required)

Bank(Required)

Branch Code(Required)

Upload proof of banking details (bank-stamped account confirmation letter)(Required)

Max. file size: 128 MB.

Marital Status(Required)

Not Married

Married in community of property

Married out of community of property

Married according to customary law

Other

Upload Marriage Certificate

Max. file size: 128 MB.

Upload Ante-nuptial contract

Max. file size: 128 MB.

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:(Required)

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Contact Person if Unreachable

Name(Required)

First Last

Relationship with contact(Required)

Cell Phone Number(Required)

Email(Required)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Postal address same as above?

Yes

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add another beneficial owner?(Required)

Yes

Beneficial Owner 2

Name(Required)

First Last

ID Number(Required)

Date of birth(Required)

MM slash DD slash YYYY

Nationality(Required)

Upload Copy Of Identity/Passport Document(Required)

Max. file size: 128 MB.

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Upload Proof Physical Address(Required)

Max. file size: 128 MB.

Postal Address same as above?(Required)

Yes

Postsl Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Upload Proof Postal Address(Required)

Max. file size: 128 MB.

Work Telephone Number(Required)

Cell Phone(Required)

Email(Required)

Tax Details

Income Tax Number(Required)

Upload Proof of ITN

Max. file size: 128 MB.

Banking Details

Account Holder Name(Required)

Account Number(Required)

Bank(Required)

Branch Code(Required)

Upload proof of bank account

Max. file size: 128 MB.

Marital Status(Required)

Not Married

Married in community of property

Married out of community of property

Married according to customary law

Other

Upload Ante-nuptial contract

Max. file size: 128 MB.

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:(Required)

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Contact person if unreachable

Name(Required)

First Last

Relationship with contact(Required)

Cell phone Number(Required)

Email Address(Required)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Postal Address Same as above?(Required)

Yes

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add another beneficial owner?(Required)

Yes

Beneficial owner 3

Name(Required)

First Last

ID Number

Identity/Passport Number(Required)

Date of birth(Required)

MM slash DD slash YYYY

Nationality(Required)

Upload Copy Of Identity/Passport Document(Required)

Max. file size: 128 MB.

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Upload Copy of Physical Adress(Required)

Max. file size: 128 MB.

Postal Address same as above?(Required)

Yes

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Upload Copy of Postal Adsress

Max. file size: 128 MB.

Work Telephone Number(Required)

Cell Phone(Required)

Email(Required)

Income Tax Number(Required)

Upload Proof of Income Tax Number(Required)

Max. file size: 128 MB.

Banking Details

Account Holder(Required)

Account Number(Required)

Bank Name(Required)

Branch Code(Required)

Upload proof of banking(Required)

Max. file size: 128 MB.

Marital Status(Required)

Not Married

Married in community of property

Married out of community of property

Married according to customary law

Other

Upload marriage certificate

Max. file size: 128 MB.

Upload ante-nuptial contract

Max. file size: 128 MB.

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:(Required)

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Contact person if unreachable

Name(Required)

First Last

Relationship with contact(Required)

Cell phone Number(Required)

Email(Required)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add another beneficial owner?(Required)

Yes

Beneficial owner 4

Name(Required)

First Last

ID Number(Required)

Date of birth(Required)

MM slash DD slash YYYY

Nationality(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Upload Copy Of Identity/Passport Document

Max. file size: 128 MB.

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Upload proof of physical address

Max. file size: 128 MB.

Postal address same as above?(Required)

Yes

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Upload proof of postal address

Max. file size: 128 MB.

Work Telephone Number(Required)

Cell Phone(Required)

Email(Required)

Income Tax Number(Required)

Upload Proof of Income Tax Number(Required)

Max. file size: 128 MB.

Banking Details

Account Holder Name(Required)

Account Number(Required)

Bank(Required)

Branch Code(Required)

Upload Proof of Banking

Max. file size: 128 MB.

Bank stamped account /confirmation letter

Marital Status(Required)

Not Married

Married in community of property

Married out of community of property

Married according to customary law

Other

Upload Marriage Certificate

Max. file size: 128 MB.

Upload Ante-Nuptial Contract

Max. file size: 128 MB.

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:(Required)

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Contact person if unreachable

Name(Required)

First Last

Relationship to contact(Required)

Cell phone Number(Required)

Email(Required)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add another beneficial owner?(Required)

Yes

Beneficial Owner 5

Name(Required)

First Last

Identity/ Passport Number(Required)

Date of birth(Required)

MM slash DD slash YYYY

Nationality(Required)

Upload Copy Of Identity/Passport Document

Max. file size: 128 MB.

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Upload Proof of physical address

Max. file size: 128 MB.

Postal address same as above?(Required)

Yes

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Upload proof of postal address

Max. file size: 128 MB.

Work Telephone Number(Required)

Cell Phone(Required)

Email(Required)

Income Tax Number(Required)

Upload proof of Income tax number(Required)

Max. file size: 128 MB.

Account Holder Name(Required)

Account Number(Required)

Bank(Required)

Branch Code(Required)

Proof of banking

Max. file size: 128 MB.

Bank stamped account /confirmation letter

Marital Status(Required)

Not Married

Married in community of property

Married out of community of property

Married according to customary law

Other

Upload Marriage Certificate

Max. file size: 128 MB.

Upload Ante-Nuptial Contract

Max. file size: 128 MB.

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:(Required)

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Contact Person if Unreachable

Name

First Last

Relationship to contact

Cell Phone

Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Identified Beneficiaries

Details of all identified beneficiaries

Name(Required)

First Last

Identity/Passport Number for beneficiary(Required)

Upload Copy Of Identity/Passport Document(Required)

Max. file size: 128 MB.

Add another beneficiary?(Required)

Yes

Beneficiary 2

Name(Required)

First Last

Identity/Passport Document for beneficiary(Required)

Upload Copy Of Identity/Passport Document(Required)

Max. file size: 128 MB.

Add another beneficiary(Required)

Yes

Beneficiary 3

Name(Required)

First Last

Identity/Passport Number for beneficiary(Required)

Upload Copy Of Identity/Passport Document(Required)

Max. file size: 128 MB.

Add another beneficiary(Required)

Yes

Beneficiary 4

Name(Required)

First Last

Identity/Passport Number for beneficiary(Required)

Upload Copy Of Identity/Passport Document(Required)

Max. file size: 128 MB.

Add another beneficiary(Required)

Yes

Beneficiary 5

Name(Required)

First Last

Identity/Passport Number for beneficiary(Required)

Upload Copy Of Identity/Passport Document

Max. file size: 128 MB.

Add another beneficiary(Required)

Yes

Beneficiary 6

Name(Required)

First Last

Identity/Passport Number for beneficiary(Required)

Upload Copy Of Identity/Passport Document(Required)

Max. file size: 128 MB.

Add another beneficiary(Required)

Yes

Beneficiary 7

Name(Required)

First Last

Identity/Passport Number for beneficiary(Required)

Upload Copy Of Identity/Passport Document(Required)

Max. file size: 128 MB.

Add another beneficiary(Required)

Yes

Beneficiary 8

Name(Required)

First Last

Identity/Passport Number for beneficiary(Required)

Upload Copy Of Identity/Passport Document(Required)

Max. file size: 128 MB.

Add another beneficiary(Required)

Yes

Beneficiary 9

Name(Required)

First Last

Identity/Passport Number for beneficiary(Required)

Upload Copy Of Identity/Passport Document(Required)

Max. file size: 128 MB.

Add another beneficiary(Required)

Yes

Beneficiary 10

Name(Required)

First Last

Identity/Passport Number for beneficiary(Required)

Upload Copy Of Identity/Passport Document(Required)

Max. file size: 128 MB.

Unidentified Beneficiaries

Indicate how the beneficiaries of the trust will be determined:(Required)

POLITICALLY EXPOSED PERSONS/FOREIGN PROMINENT PUBLIC OFFICIAL/DOMESTIC PROMINENT INFLUENTIAL PERSON

Are you or any of your family members (i.e. spouse or life partner, children and their spouses, parents, ex-spouses or ex-life partners, or siblings and their spouses) or close associates:(Required)

President or deputy president of South Africa (current or former)

Cabinet minister or deputy minister (current or former)

Premier or MEC of a province (current or former)

Mayor, Head, accounting officer, CFO or a manager of a national or provincial municipality (current or former)

Leader of a political party (current or former)

Member of a royal family (current or former)

Senior traditional leader (current or former)

Chairperson, CEO, accounting authority, CFO or chief investment officer of a public entity (current or former)

Judge (current or former)

Ambassador, high commissioner or other representative of a foreign country based in South Africa (current or former)

Chairman of board of directors, chairperson of audit committee, executive officer or CFO of a company doing business with the government (current or former)

Head of state of foreign country (current or former)

Cabinet member of foreign country (current or former)

Senior member of a political party, local or foreign (current or former)

Senior judicial officer, local or foreign (current or former)

Senior executive of a state-owned entity, local or foreign (current or former)

High rank in the military, local or foreign (current or former)

None of the above

Declaration / Indemnity

I hereby declare under oath/ hereby truly affirm that to the best of my knowledge and belief the aforementioned statements are true, complete and correct. I hereby undertake to inform Reenen van Reenen and his associated firms immediately in writing of any change of details and formally indemnify Reenen van Reenen and his associated firms from any administrative or other sanctions of whatsoever nature in relation to non-compliance with the Financial Intelligence Centre Act 38 of 2001 (FICA), or any other statutory regulation, resultant from my negligent or deliberate misrepresentation.

Name(Required)

First Last

Do you know and understand the contents of the above declaration?(Required)

Yes

Do you have any objection to taking the prescribed oath?(Required)

Yes

Do you consider the prescribed oath to be binding on your conscience?(Required)

Yes

Date of acceptance(Required)

DD slash MM slash YYYY

Place of acceptance(Required)

Commissioner of Oaths

FOR OFFICE USE ONLY I certify that the deponents have acknowledged that they know and understand the contents of this declaration, which was sworn to/affirmed before me, and the deponents’ signatures were placed thereon in my presence.

Stamp