Section II:
CLIENT´S IDENTIFICATION |
Complete Name: |
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Last name |
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Second Last Name |
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First Name |
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Middle Name |
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Date of Birth: |
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Day |
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Month |
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Year |
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Place of Birth: |
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City |
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State/Province |
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Country |
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Occupation |
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Civil Status |
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Identification Number: |
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Passport |
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Drivers License |
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Sex: |
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Section II
CLIENT´S WORK INFORMATION & ADDRESS: |
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Name of company /business: |
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Work’s physical address: (Do not use PO Box, but physical address) |
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Number: |
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Street/Avenue |
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Additional signs : |
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City: |
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Country: |
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Zip Code: |
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Work Phone #: |
Area Code: (
) Number: (
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Fax: |
Area Code:: (
) Number: (
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E Mails |
1)
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2)
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CLIENT’S RESIDENCY ADDRESS: |
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Community Name (if any) : |
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Work’s physical address: (Do not use PO Box, but physical address) |
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Number: |
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Street/Avenue |
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Additional signs: |
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City: |
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Country: |
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Zip Code: |
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Phone: |
Area Code: (
) Number: (
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Fax: |
Area Code:(
) Number: (
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E mail |
1)
2)
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Section III
ORIGIN OF FUNDS:
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Please describe the ORIGIN OF THE FUNDS THAT YOU WILL BE SENDING TO OUR ACCOUNT. Be as detailed as you can and if you need to, use additional white sheets of paper to complete the information. You may also include other support documentation such as accounting certificates, tax declarations and/or a letter from your local bank’s manager. |
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Section IV
SPECIAL INSTRUCTIONS: |
You’ve hired GES´s services, which will empower us to receive, keep in custody and pay monies, on your behalf and account. These services include, but are not limited, to the payment of the obligations that you, or those people you have authorized in the escrow agreement, request from us. If you have a particular and/or special instruction other than the one you just gave to us, we ask you to please include it now. |
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| I hereby declare UNDER OATH that (A.) The information contained herein is true and accurate and (B.) That the origin and/or final destination of the funds that are going to be credited into or debited from my escrow account have a legitimate source and purpose. |
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Section V
AUTHORIZED PERSONS WHO MAY REQUEST PAYMENTS
WITH YOUR ESCROW ACCOUNT´S FUNDS |
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PLEASE MARK WITH THE WORDS “YES” OR “NO” THE AUTHORIZED PERSONS AND THE LIMITATION OF AMOUNT (IF ANY) IN US DOLLARS.
IF THE AUTHORIZED PERSON IS NOT AFFECTED BY A LIMITATION OF AMOUNT, PLEASE INDICATE: “NO LIMIT”.
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| I.-Authorization for the members of GLOBAL LEGAL ADVISORS Law Firm: |
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| II.- Authorization for the members of OTHER LAW FIRM AND/OR LAWYER (S) /NOTARY PUBLIC(S): |
| NAME OF LAW FIRM:
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III.- Authorization for OTHER PERSONS (Please indicate their FULL NAMES ): |
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I sign on |
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