KYC Details - belmoney

Belmoney — KYC Form

Generating PDF…

For personal customers

Personal Information

Full Name

PIN Number

Passport / Identity document number

Place of Birth

Date of Birth

Profession

Company name

Monthly net salary

Transfer Details

Beneficiary's name

Relationship with Beneficiary

Source of funds

Primary purpose of remittance

Politically Exposed Person (PEP)

Are you a politically exposed person?

Yes No

Are you a family member or close associate of a politically exposed person?

Yes No

Client signature — sign with your finger or mouse

✍ Sign here

I declare that the funds received / sent are not intended for any activity related to money laundering, financing of terrorism or any other illegal activity. I am fully aware this can be used by Belmoney Transfer SPRL as basis to carry out the analysis and verification it considers pertinent and to inform the competent authorities in case of investigation and determination of transactions considered to be unusual or suspicious.

I confirm that all above information is true.

Brussels,

By signing this form, I acknowledge that I read and fully accept Belmoney Transfer SPRL terms and conditions and am well aware of the conditions. I authorised BT to use my personal information in accordance to GDPR legislation and its Privacy Policy made available to me on all of Belmoney Transfer SPRL stores.