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RETAIL - INDIVIDUAL CUSTOMER DECLARATION FORM

  PART A: INFORMATION ON CUSTOMER [to be filled by customer]
a)   Customer Identity 

Name (*)
Please field name!
Nationality (*)
Invalid Input
Business/Employment Type
Invalid Input
Address (*)
Please field Address!
Postcode (*)
Please field Postcode!
Country
Invalid Input
NRIC / Passport / other ID / Business Reg. No. (*)
Please field NRIC / Passport / other ID / Business Reg. No.!
Occupation
Invalid Input
Telephone No (*)
Please field Telephone No!
Town (*)
Please filed Town!
State (*)
Please field State!

Invalid Input
Please attached a ID's copy..
Purpose of transaction
[Please mark (X) where relevant]

Invalid Input
 
Source of Fund
Invalid Input
Email Address (*)
Invalid Input

b)	Are You Transacting On Behalf Of Other Persons? 


Invalid Input

Name
Please field Name!
Nationality
Please field Nationality!
Business/Employment Type
Invalid Input
Address
Please field Address!
Postcode
Please field Postcode!
Country
Invalid Input
NRIC / Passport / other ID / Business Reg. No.
Invalid Input
Occupation
Invalid Input
Telephone No
Please field Telephone No!
Town
Please field Town
State
Please field State!