The USA PATRIOT Act. The USA PATRIOT Act is designed to detect, deter, and punish terrorists in the United States and abroad. The Act imposes new anti-money laundering requirements on brokerage firms and financial institutions. Since April 24, 2002 all brokerage firms have been required to have new, comprehensive anti-money laundering programs. To help you understand these efforts, we want to provide you with some information about money laundering and our steps to implement the USA PATRIOT Act. What is money laundering? Money laundering is the process of disguising illegally obtained money so that the funds appear to come from legitimate sources or activities. Money laundering occurs in connection with a wide variety of crimes, including illegal arms sales, drug trafficking, robbery, fraud, racketeering, and terrorism. How big is the problem and why is it important? The use of the U.S. financial system by criminals to facilitate terrorism or other crimes could well taint our financial markets. According to the U.S. State Department, one recent estimate puts the amount of worldwide money laundering activity at $1 trillion a year. What are we required to do to eliminate money laundering? Under rules required by the USA PATRIOT Act, our anti-money laundering program must designate a special compliance officer, set up employee training, conduct independent audits, and establish policies and procedures to detect and report suspicious transaction and ensure compliance with such laws. As part of our required program, we may ask you to provide various identification documents or other information. Until you provide the information or documents we need, we may not be able to effect any transactions for you. ANTI-MONEY LAUNDERING INFORMATION FORM The following is required in accordance with the AML provision of the USA PATRIOT ACT. (Please fill out and return with requested documentation.) INVESTOR NAME: _________________________________________________________________ LEGAL ADDRESS: _________________________________________________________________ _________________________________________________________________ SSN# or TAX ID# OF INVESTOR: __________________________________________________________________ FOR INVESTORS WHO ARE INDIVIDUALS: YEARLY INCOME: __________________________________ AGE: _____________________________ NET WORTH (excluding value of primary residence): _______________________________________ OCCUPATION: ___________________________________________________________________ ADDRESS OF EMPLOYER: ___________________________________________________________ ___________________________________________________________ INVESTMENT OBJECTIVE(S): ________________________________________________________
Appears in 1 contract
Samples: Subscription Agreement (Lifeapps Digital Media Inc.)
The USA PATRIOT Act. The USA PATRIOT Act is designed to detect, deter, and punish terrorists in the United States and abroad. The Act imposes new anti-money laundering requirements on brokerage firms and financial institutions. Since April 24, 2002 2002, all brokerage firms have been required to have new, comprehensive anti-money laundering programs. To help you understand these efforts, we want to provide you with some information about money laundering and our steps to implement the USA PATRIOT Act. What is money laundering? Money laundering is the process of disguising illegally obtained money so that the funds appear to come from legitimate sources or activities. Money laundering occurs in connection with a wide variety of crimes, including illegal arms sales, drug trafficking, robbery, fraud, racketeering, and terrorism. How big is the problem and why is it important? The use of the U.S. financial system by criminals to facilitate terrorism or other crimes could well taint our financial markets. According to the U.S. State Department, one recent estimate puts the amount of worldwide money laundering activity at $1 trillion a year. What are we required to do to eliminate money laundering? Under rules required by the USA PATRIOT Act, our anti-money laundering program must designate a special compliance officer, set up employee training, conduct independent audits, and establish policies and procedures to detect and report suspicious transaction and ensure compliance with such laws. As part of our required program, we may ask you to provide various identification documents or other information. Until you provide the information or documents we need, we may not be able to effect any transactions for you. ANTI-MONEY LAUNDERING INFORMATION FORM The following is required in accordance with the AML provision of the USA PATRIOT ACT. (Please fill out and return with requested documentation.) INVESTOR NAME: ______________________________________________________________________________ LEGAL ADDRESS: ______________________________________________________________________________ _____________________________________________________________________________ SSN# or TAX ID# OF INVESTOR: __________________________________________________________________ FOR INVESTORS WHO ARE INDIVIDUALS: YEARLY INCOME: __________________________________ AGE: _____________________________ NET WORTH (excluding value of primary residence): _______________________________________ OCCUPATIONYEARLY INCOME: _____________________________________________________________________________ ADDRESS OF EMPLOYERNET WORTH: ___________________________________________________________ _______________________* * For purposes of calculating your net worth in this form, (a) your primary residence shall not be included as an asset; (b) indebtedness secured by your primary residence, up to the estimated fair market value of your primary residence at the time of your purchase of the Securities, shall not be included as a liability (except that if the amount of such indebtedness outstanding at the time of your purchase of the Securities exceeds the amount outstanding sixty (60) days before such time, other than as a result of the acquisition of your primary residence, the amount of such excess shall be included as a liability); and (c) indebtedness that is secured by your primary residence in excess of the estimated fair market value of your primary residence at the time of your purchase of the Securities shall be included as a liability. INVESTMENT OBJECTIVE(S) (FOR ALL INVESTORS): _________________________________________________ ADDRESS OF BUSINESS OR OF EMPLOYER: ________________________________________________________ INVESTMENT OBJECTIVE(S): FOR INVESTORS WHO ARE INDIVIDUALS: AGE: _____________________________________________________ FOR INVESTORS WHO ARE INDIVIDUALS: OCCUPATION: _____________________________________________ FOR INVESTORS WHO ARE ENTITIES: NATURE OF BUSINESS: __________________________________________
Appears in 1 contract
The USA PATRIOT Act. The USA PATRIOT Act is designed to detect, deter, and punish terrorists in the United States and abroad. The Act imposes new anti-money laundering requirements on brokerage firms and financial institutions. Since April 24, 2002 all brokerage firms have been required to have new, comprehensive anti-money laundering programs. To help you understand these efforts, we want to provide you with some information about money laundering and our steps to implement the USA PATRIOT Act. What is money laundering? Money laundering is the process of disguising illegally obtained money so that the funds appear to come from legitimate sources or activities. Money laundering occurs in connection with a wide variety of crimes, including illegal arms sales, drug trafficking, robbery, fraud, racketeering, and terrorism. How big is the problem and why is it important? The use of the U.S. financial system by criminals to facilitate terrorism or other crimes could well taint our financial markets. According to the U.S. State Department, one recent estimate puts the amount of worldwide money laundering activity at $1 trillion a year. What are we required to do to eliminate money laundering? Under rules required by the USA PATRIOT Act, our anti-money laundering program must designate a special compliance officer, set up employee training, conduct independent audits, and establish policies and procedures to detect and report suspicious transaction and ensure compliance with such laws. As part of our required program, we may ask you to provide various identification documents or other information. We will ask you for your name, address, date of birth and other information that will allow us to identify you. We will ask to see a non-expired valid issued government identification, such as your driver’s license or other identifying documents. Until you provide the information or documents we need, we may not be able to effect any transactions for you. ANTI-MONEY LAUNDERING INFORMATION FORM The following is required in accordance with the AML provision of the USA PATRIOT ACT. (Please fill out and return with requested documentation.) INVESTOR NAME: _________________________________________________________________ LEGAL ADDRESS: __________________________________________________________ ________ _____________________________________________________________________ SSN# or TAX ID# OF INVESTOR: __________________________________________________________________ FOR INVESTORS WHO ARE INDIVIDUALS: YEARLY INCOME: __________________________________ AGE: _____________________________ NET WORTH (excluding value of primary residence): _______________________________________ OCCUPATION: ___________________________________________________________________ ADDRESS OF EMPLOYER: ___________________________________________________________ ___________________________________________________________ INVESTMENT OBJECTIVE(S): ________________________________________________________
Appears in 1 contract
Samples: Subscription Agreement (Separation Degrees - One, Inc.)
The USA PATRIOT Act. The USA PATRIOT Act is designed to detect, deter, and punish terrorists in the United States and abroad. The Act imposes new anti-money laundering requirements on brokerage firms and financial institutions. Since April 24, 2002 all brokerage firms have been required to have new, comprehensive anti-money laundering programs. To help you understand these efforts, we want to provide you with some information about money laundering and our steps to implement the USA PATRIOT Act. What is money laundering? Money laundering is the process of disguising illegally obtained money so that the funds appear to come from legitimate sources or activities. Money laundering occurs in connection with a wide variety of crimes, including illegal arms sales, drug trafficking, robbery, fraud, racketeering, and terrorism. How big is the problem and why is it important? The use of the U.S. financial system by criminals to facilitate terrorism or other crimes could well taint our financial markets. According to the U.S. State Department, one recent estimate puts the amount of worldwide money laundering activity at $1 trillion a year. What are we required to do to eliminate money laundering? Under rules required by the USA PATRIOT Act, our anti-money laundering program must designate a special compliance officer, set up employee training, conduct independent audits, and establish policies and procedures to detect and report suspicious transaction and ensure compliance with such laws. As part of our required program, we may ask you to provide various identification documents or other information. Until you provide the information or documents we need, we may not be able to effect any transactions for you. ANTI-MONEY LAUNDERING INFORMATION FORM The following is required in accordance with the AML provision of the USA PATRIOT ACT. (Please fill out and return with requested documentation.) INVESTOR NAME: ____________________________________________ LEGAL ADDRESS: ________________________________________________________________________________ LEGAL ADDRESS_______________________ ______________________________________________________________________________________ _______________________ INVESTMENT OBJECTIVE: ________________________________________________________________________ _________________________________________________________________ SSN# or TAX ID# OF INVESTOR: __________________________________________________________________ FOR INVESTORS WHO ARE INDIVIDUALSENTITIES: YEARLY INCOMETYPE OF BUSINESS: __________________________________ AGE: _____________________________ NET WORTH (excluding value of primary residence): _______________________________________ OCCUPATION: ___________________________________________________________________ ADDRESS OF EMPLOYER: ___________________________________________________________ ___________________________________________________________ INVESTMENT OBJECTIVE(S): ________________________________________________________
Appears in 1 contract
The USA PATRIOT Act. The USA PATRIOT Act is designed to detect, deter, and punish terrorists in the United States and abroad. The Act imposes new anti-money laundering requirements on brokerage firms and financial institutions. Since April 24, 2002 all brokerage firms have been required to have new, comprehensive anti-money laundering programs. To help you understand these efforts, we want to provide you with some information about money laundering and our steps to implement the USA PATRIOT Act. What is money laundering? Money laundering is the process of disguising illegally obtained money so that the funds appear to come from legitimate sources or activities. Money laundering occurs in connection with a wide variety of crimes, including illegal arms sales, drug trafficking, robbery, fraud, racketeering, and terrorism. How big is the problem and why is it important? The use of the U.S. financial system by criminals to facilitate terrorism or other crimes could well taint our financial markets. According to the U.S. State Department, one recent estimate puts the amount of worldwide money laundering activity at $1 trillion a year. What are we required to do to eliminate money laundering? Under rules required by the USA PATRIOT Act, our anti-money laundering program must designate a special compliance officer, set up employee training, conduct independent audits, and establish policies and procedures to detect and report suspicious transaction and ensure compliance with such laws. As part of our required program, we may ask you to provide various identification documents or other information. Until you provide the information or documents we need, we may not be able to effect any transactions for you. ANTI-MONEY LAUNDERING INFORMATION FORM The following is required in accordance with the AML provision of the USA PATRIOT ACT. (Please fill out and return with requested documentation.) INVESTOR NAME: _________________________________________________________________ LEGAL ADDRESS: _________________________________________________________________ _________________________________________________________________ SSN# or TAX ID# OF INVESTOR: __________________________________________________________________ FOR INVESTORS WHO ARE INDIVIDUALS: YEARLY INCOME: __________________________________ AGE: _____________________________ NET WORTH (excluding value of primary residence): _______________________________________ OCCUPATION: _____________________________________________________________________ ADDRESS OF EMPLOYERNET WORTH: _________________________________________________________________________ * * For purposes of calculating your net worth in this form, (a) your primary residence shall not be included as an asset; (b) indebtedness secured by your primary residence, up to the estimated fair market value of your primary residence at the time of your purchase of the securities, shall not be included as a liability (except that if the amount of such indebtedness outstanding at the time of your purchase of the securities exceeds the amount outstanding 60 days before such time, other than as a result of the acquisition of your primary residence, the amount of such excess shall be included as a liability); and (c) indebtedness that is secured by your primary residence in excess of the estimated fair market value of your primary residence at the time of your purchase of the securities shall be included as a liability. INVESTMENT OBJECTIVE(S) FOR ALL INVESTORS: __________________________ ADDRESS OF BUSINESS OR OF EMPLOYER:_____________________________________________ _____________________________________ FOR INVESTORS WHO ARE INDIVIDUALS: AGE: _____________________________ INVESTMENT OBJECTIVE(SFOR INVESTORS WHO ARE INDIVIDUALS: OCCUPATION: _____________________________________ FOR INVESTORS WHO ARE ENTITIES: Business Sector/Industry): ____________________________________ BANK SECRECY ACT (BSA) REQUIREMENT Identify and complete for each of the 25% or more beneficial owner(s) of the entity as defined below:1 Name: ______________________________________ Percent of Ownership: ___________________ Home Address (No PO Box):__________________________________________________________ Phone Number: _________________ Email Address: ________________________________ Title (if applicable): ___________________________________________________________ Social Security Number: ___________________ Date of Birth: ________________ Please provide documents to verify the identity of the beneficial owner(s), including a current valid issued government id for each beneficial owner identified above. 1 Beneficial Owner: each individual, if any, who directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise owns 25% or more of the equity interests of a legal entity investor: (A) a single individual with significant responsibility to control, manage or direct a legal entity investor, including, (i) an executive officer or senior manager (e.g. Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, Managing Member, General Partner, President, Vice President or Treasurer) or (ii) any other individual who regularly performs similar functions or (B) if a trust owns directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, 25% or more of the equity interests of a legal entity investor, the beneficial owner shall mean the trustee. It is the ultimate beneficial owner(s) that must be identified and not nominees.
Appears in 1 contract
Samples: Subscription Agreement (Compass Therapeutics, Inc.)
The USA PATRIOT Act. The USA PATRIOT Act is designed to detect, deter, and punish terrorists in the United States and abroad. The Act imposes new anti-money laundering requirements on brokerage firms and financial institutions. Since April 24, 2002 all brokerage firms have been required to have new, comprehensive anti-money laundering programs. To help you understand these efforts, we want to provide you with some information about money laundering and our steps to implement the USA PATRIOT Act. What is money laundering? Money laundering is the process of disguising illegally obtained money so that the funds appear to come from legitimate sources or activities. Money laundering occurs in connection with a wide variety of crimes, including illegal arms sales, drug trafficking, robbery, fraud, racketeering, and terrorism. How big is the problem and why is it important? The use of the U.S. financial system by criminals to facilitate terrorism or other crimes could well taint our financial markets. According to the U.S. State Department, one recent estimate puts the amount of worldwide money laundering activity at $1 trillion a year. What are we required to do to eliminate money laundering? Under rules required by the USA PATRIOT Act, our anti-money laundering program must designate a special compliance officer, set up employee training, conduct independent audits, and establish policies and procedures to detect and report suspicious transaction and ensure compliance with such laws. As part of our required program, we may ask you to provide various identification documents or other information. Until you provide the information or documents we need, we may not be able to effect any transactions for you. ANTI-MONEY LAUNDERING INFORMATION FORM The following is required in accordance with the AML provision of the USA PATRIOT ACT. (Please fill out and return with requested documentation.) INVESTOR PURCHASER NAME: _________________________________________________________________ LEGAL ADDRESS: ___________________________________________________________ ___________________________________________________________ SSN or TAX ID# OF PURCHASER: ___________________________________________________________ YEARLY INCOME:_______________________________________________________________ SSN# or TAX ID# OF INVESTOR: __________________________________________________________________ FOR INVESTORS WHO ARE INDIVIDUALS: YEARLY INCOME: __________________________________ AGE: _____________________________ NET WORTH (excluding value of primary residence): _______________________________________ OCCUPATION: WORTH:___________________________________________________________________ ADDRESS OF EMPLOYER_* * For purposes of calculating “net worth”: (i) your primary residence shall not be included as an asset; (ii) indebtedness that is secured by your primary residence, up to the estimated fair market value of the primary residence at the time of subscription, shall not be included as a liability (except that if the amount of such indebtedness outstanding at the time of subscription exceeds the amount outstanding sixty (60) days before such time, other than as a result of the acquisition of the primary residence, the amount of such excess shall be included as a liability); and (iii) indebtedness that is secured by your primary residence in excess of the estimated fair market value of the primary residence at the time of subscription shall be included as a liability. INVESTMENT OBJECTIVE(S) FOR ALL PURCHASERS: ________________________________ ADDRESS OF BUSINESS OR OF EMPLOYER: ________________________________________ _____________________________ FOR PURCHASERS WHO ARE INDIVIDUALS: AGE: ________________________________________ INVESTMENT OBJECTIVE(SFOR PURCHASERS WHO ARE INDIVIDUALS: OCCUPATION: ________________________________________ FOR PURCHASERS WHO ARE ENTITIES: Business Sector/Industry): ___________________________ BANK SECRECY ACT (BSA) REQUIREMENT Identify and complete for each of the 25% or more beneficial owner(s) of the entity as defined below:1 Name:______________________________ Percent of Ownership:___________ Home Address (No P.O. Box): ________________________________________________ Phone Number:__________________________________ Email Address:__________________________________ Title (if applicable): _________________________________________________ Social Security Number:__________________________________ Date of Birth:___________ Please provide documents to verify the identity of the beneficial owner(s), including a current valid issued government ID for each beneficial owner identified above.
Appears in 1 contract
The USA PATRIOT Act. The USA PATRIOT Act is designed to detect, deter, and punish terrorists in the United States and abroad. The Act imposes new anti-money laundering requirements on brokerage firms and financial institutions. Since April 24, 2002 all brokerage firms have been required to have new, comprehensive anti-money laundering programs. To help you understand these efforts, we want to provide you with some information about money laundering and our steps to implement the USA PATRIOT Act. What is money laundering? Money laundering is the process of disguising illegally obtained money so that the funds appear to come from legitimate sources or activities. Money laundering occurs in connection with a wide variety of crimes, including illegal arms sales, drug trafficking, robbery, fraud, racketeering, and terrorism. How big is the problem and why is it important? The use of the U.S. financial system by criminals to facilitate terrorism or other crimes could well taint our financial markets. According to the U.S. State Department, one recent estimate puts the amount of worldwide money laundering activity at $1 trillion a year. What are we required to do to eliminate money laundering? Under rules required by the USA PATRIOT Act, our anti-money laundering program must designate a special compliance officer, set up employee training, conduct independent audits, and establish policies and procedures to detect and report suspicious transaction and ensure compliance with such laws. As part of our required program, we may ask you to provide various identification documents or other information. Until you provide the information or documents we need, we may not be able to effect any transactions for you. ANTI-MONEY LAUNDERING INFORMATION FORM The following is required in accordance with the AML provision of the USA PATRIOT ACT. (Please fill out and return with requested documentation.) INVESTOR NAME: ________________________LEGAL ADDRESS: SSN# or TAX ID# OF INVESTOR: YEARLY INCOME: FOR INVESTORS WHO ARE INDIVIDUALS: AGE: _________________________________________ LEGAL ADDRESS: _________________________________________________________________ _________________________________________________________________ SSN# or TAX ID# OF INVESTOR: __________________________________________________________________ FOR INVESTORS WHO ARE INDIVIDUALS: YEARLY INCOME: __________________________________ AGE: _____________________________ NET WORTH (excluding value of primary residence): _______________________________________ OCCUPATIONWORTH: ________________________________________________________________________________ ADDRESS OF EMPLOYER* * For purposes of calculating your net worth in this form, (a) your primary residence shall not be included as an asset; (b) indebtedness secured by your primary residence, up to the estimated fair market value of your primary residence at the time of your purchase of the securities, shall not be included as a liability (except that if the amount of such indebtedness outstanding at the time of your purchase of the securities exceeds the amount outstanding 60 days before such time, other than as a result of the acquisition of your primary residence, the amount of such excess shall be included as a liability); and (c) indebtedness that is secured by your primary residence in excess of the estimated fair market value of your primary residence at the time of your purchase of the securities shall be included as a liability. FOR INVESTORS WHO ARE INDIVIDUALS: OCCUPATION: ___________________________________________________________ ___________________________________________________________ INVESTMENT OBJECTIVE(S): ________________________________________________________ADDRESS OF BUSINESS OR OF EMPLOYER: FOR INVESTORS WHO ARE ENTITIES:
Appears in 1 contract
The USA PATRIOT Act. The USA PATRIOT Act is designed to detect, deter, and punish terrorists in the United States and abroad. The Act imposes new anti-money laundering requirements on brokerage firms and financial institutions. Since April 24, 2002 all brokerage firms have been required to have new, comprehensive anti-money laundering programs. To help you understand these efforts, we want to provide you with some information about money laundering and our steps to implement the USA PATRIOT Act. What is money laundering? Money laundering is the process of disguising illegally obtained money so that the funds appear to come from legitimate sources or activities. Money laundering occurs in connection with a wide variety of crimes, including illegal arms sales, drug trafficking, robbery, fraud, racketeering, and terrorism. How big is the problem and why is it important? The use of the U.S. financial system by criminals to facilitate terrorism or other crimes could well taint our financial markets. According to the U.S. State Department, one recent estimate puts the amount of worldwide money laundering activity at $1 trillion a year. What are we required to do to eliminate money laundering? Under rules required by the USA PATRIOT Act, our anti-money laundering program must designate a special compliance officer, set up employee training, conduct independent audits, and establish policies and procedures to detect and report suspicious transaction and ensure compliance with such laws. As part of our required program, we may ask you to provide various identification documents or other information. Until you provide the information or documents we need, we may not be able to effect any transactions for you. ANTI-MONEY LAUNDERING INFORMATION FORM The following is required in accordance with the AML provision of the USA PATRIOT ACT. (Please fill out and return with requested documentation.) INVESTOR NAME: _________________________________________________________________ LEGAL ADDRESS: _________________________________________________________________ _________________________________________________________________ SSN# or TAX ID# OF INVESTOR: __________________________________________________________________ FOR INVESTORS WHO ARE INDIVIDUALS: YEARLY INCOME: __________________________________ AGE: _____________________________ NET WORTH (excluding value of primary residence): _______________________________________ OCCUPATIONFOR INVESTORS WHO ARE INDIVIDUALS: AGE: __________________________________ NET WORTH: ___________________________________________________________________ ADDRESS OF EMPLOYER* * For purposes of calculating your net worth in this form, (a) your primary residence shall not be included as an asset; (b) indebtedness secured by your primary residence, up to the estimated fair market value of your primary residence at the time of your purchase of the securities, shall not be included as a liability (except that if the amount of such indebtedness outstanding at the time of your purchase of the securities exceeds the amount outstanding 60 days before such time, other than as a result of the acquisition of your primary residence, the amount of such excess shall be included as a liability); and (c) indebtedness that is secured by your primary residence in excess of the estimated fair market value of your primary residence at the time of your purchase of the securities shall be included as a liability. FOR INVESTORS WHO ARE INDIVIDUALS: OCCUPATION: ________________________ ADDRESS OF BUSINESS OR OF EMPLOYER: _____________________________________ ________________________________________________________________________________ INVESTMENT OBJECTIVE(S): FOR INVESTORS WHO ARE ENTITIES: YEARLY INCOME: ____________ NET WORTH: ____________ TYPE OF BUSINESS: ____________________________________ INVESTMENT OBJECTIVE(S) (FOR ALL INVESTORS): __________________________
Appears in 1 contract
The USA PATRIOT Act. The USA PATRIOT Act is designed to detect, deter, and punish terrorists in the United States and abroad. The Act imposes new anti-money laundering requirements on brokerage firms and financial institutions. Since April 24, 2002 all brokerage firms have been required to have new, comprehensive anti-money laundering programs. To help you understand these efforts, we want to provide you with some information about money laundering and our steps to implement the USA PATRIOT Act. What is money laundering? Money laundering is the process of disguising illegally obtained money so that the funds appear to come from legitimate sources or activities. Money laundering occurs in connection with a wide variety of crimes, including illegal arms sales, drug trafficking, robbery, fraud, racketeering, and terrorism. How big is the problem and why is it important? The use of the U.S. financial system by criminals to facilitate terrorism or other crimes could well taint our financial markets. According to the U.S. State Department, one recent estimate puts the amount of worldwide money laundering activity at $1 trillion a year. What are we required to do to eliminate money laundering? Under rules required by the USA PATRIOT Act, our anti-money laundering program must designate a special compliance officer, set up employee training, conduct independent audits, and establish policies and procedures to detect and report suspicious transaction and ensure compliance with such laws. As part of our required program, we may ask you to provide various identification documents or other information. Until you provide the information or documents we need, we may not be able to effect any transactions for you. ANTI-MONEY LAUNDERING INFORMATION FORM The following is required in accordance with the AML provision of the USA PATRIOT ACT. (Please fill out and return with requested documentation.) INVESTOR NAME: :______________________________________________ LEGAL ADDRESS:_______________________________________________________________________________ LEGAL ADDRESS: INVESTMENT OBJECTIVE:_________________________________________________________________ _________________________________________________________________ SSN# or TAX ID# OF INVESTOR: __________________________________________________________________ FOR INVESTORS WHO ARE INDIVIDUALSENTITIES: YEARLY INCOME: __________________________________ AGE: _____________________________ NET WORTH (excluding value of primary residence): _______________________________________ OCCUPATION: TYPE OF BUSINESS:___________________________________________________________________ ADDRESS OF EMPLOYER: ___________________________________________________________ ___________________________________________________________ INVESTMENT OBJECTIVE(S): ________________________________________________________
Appears in 1 contract
The USA PATRIOT Act. The USA PATRIOT Act is designed to detect, deter, and punish terrorists in the United States and abroad. The Act imposes new anti-money laundering requirements on brokerage firms and financial institutions. Since April 24, 2002 all brokerage firms have been required to have new, comprehensive anti-money laundering programs. To help you understand these efforts, we want to provide you with some information about money laundering and our steps to implement the USA PATRIOT Act. What is money laundering? Money laundering is the process of disguising illegally obtained money so that the funds appear to come from legitimate sources or activities. Money laundering occurs in connection with a wide variety of crimes, including illegal arms sales, drug trafficking, robbery, fraud, racketeering, and terrorism. How big is the problem and why is it important? The use of the U.S. financial system by criminals to facilitate terrorism or other crimes could well taint our financial markets. According to the U.S. State Department, one recent estimate puts the amount of worldwide money laundering activity at $1 trillion a year. What are we required to do to eliminate money laundering? Under rules required by the USA PATRIOT Act, our anti-money laundering program must designate a special compliance officer, set up employee training, conduct independent audits, and establish policies and procedures to detect and report suspicious transaction and ensure compliance with such laws. As part of our required program, we may ask you to provide various identification documents or other information. Until you provide the information or documents we need, we may not be able to effect any transactions for you. ANTI-MONEY LAUNDERING INFORMATION FORM The following is required in accordance with the AML provision of the USA PATRIOT ACT. (Please fill out and return with requested documentation.) INVESTOR NAME: _________________________________________________________________ LEGAL ADDRESS: _________________________________________________________________ _________________________________________________________________ SSN# or TAX ID# OF INVESTOR: __________________________________________________________________ FOR INVESTORS WHO ARE INDIVIDUALS: YEARLY INCOME: __________________________________ AGE: _____________________________ NET WORTH (excluding value of primary residence): _______________________________________ OCCUPATIONNET WORTH: ___________________________________________________________________ ADDRESS OF EMPLOYER* * For purposes of calculating your net worth in this form, (a) your primary residence shall not be included as an asset; (b) indebtedness secured by your primary residence, up to the estimated fair market value of your primary residence at the time of your purchase of the securities, shall not be included as a liability (except that if the amount of such indebtedness outstanding at the time of your purchase of the securities exceeds the amount outstanding 60 days before such time, other than as a result of the acquisition of your primary residence, the amount of such excess shall be included as a liability); and (c) indebtedness that is secured by your primary residence in excess of the estimated fair market value of your primary residence at the time of your purchase of the securities shall be included as a liability. INVESTMENT OBJECTIVE(S) FOR ALL INVESTORS: ___________________________ ADDRESS OF BUSINESS OR OF EMPLOYER: _________________________________ _________________________________ FOR INVESTORS WHO ARE INDIVIDUALS: AGE: ____________________________ INVESTMENT OBJECTIVE(S): FOR INVESTORS WHO ARE INDIVIDUALS: OCCUPATION: ___________________ FOR INVESTORS WHO ARE ENTITIES: NATURE OF BUSINESS (type of sector or industry): ______________________________________
Appears in 1 contract
The USA PATRIOT Act. The USA PATRIOT Act is designed to detect, deter, and punish terrorists in the United States and abroad. The Act imposes new anti-money laundering requirements on brokerage firms and financial institutions. Since April 24, 2002 all brokerage firms have been required to have new, comprehensive anti-money laundering programs. To help you understand these efforts, we want to provide you with some information about money laundering and our steps to implement the USA PATRIOT Act. What is money laundering? Money laundering is the process of disguising illegally obtained money so that the funds appear to come from legitimate sources or activities. Money laundering occurs in connection with a wide variety of crimes, including illegal arms sales, drug trafficking, robbery, fraud, racketeering, and terrorism. How big is the problem and why is it important? The use of the U.S. financial system by criminals to facilitate terrorism or other crimes could well taint our financial markets. According to the U.S. State Department, one recent estimate puts the amount of worldwide money laundering activity at $1 trillion a year. What are we required to do to eliminate money laundering? Under rules required by the USA PATRIOT Act, our anti-money laundering program must designate a special compliance officer, set up employee training, conduct independent audits, and establish policies and procedures to detect and report suspicious transaction and ensure compliance with such laws. As part of our required program, we may ask you to provide various identification documents or other information. Until you provide the information or documents we need, we may not be able to effect any transactions for you. ANTI-MONEY LAUNDERING INFORMATION FORM The following is required in accordance with the AML provision of the USA PATRIOT ACT. (Please fill out and return with requested documentation.) INVESTOR NAME: _________________________________________________________________ LEGAL ADDRESS: _________________________________________________________________ _________________________________________________________________ SSN# or TAX ID# OF INVESTOR: __________________________________________________________________ FOR INVESTORS WHO ARE INDIVIDUALS: YEARLY INCOME: __________________________________ AGE: _____________________________ NET WORTH (excluding value of primary residence): _______________________________________ OCCUPATIONFOR INVESTORS WHO ARE INDIVIDUALS: AGE: __________________________ NET WORTH: ___________________________________________________________________ ADDRESS OF EMPLOYER* * For purposes of calculating your net worth in this form, (a) your primary residence shall not be included as an asset; (b) indebtedness secured by your primary residence, up to the estimated fair market value of your primary residence at the time of your purchase of the securities, shall not be included as a liability (except that if the amount of such indebtedness outstanding at the time of your purchase of the securities exceeds the amount outstanding 60 days before such time, other than as a result of the acquisition of your primary residence, the amount of such excess shall be included as a liability); and (c) indebtedness that is secured by your primary residence in excess of the estimated fair market value of your primary residence at the time of your purchase of the securities shall be included as a liability. FOR INVESTORS WHO ARE INDIVIDUALS: OCCUPATION: _____________________________ ADDRESS OF BUSINESS OR OF EMPLOYER: _______________________________ _____________________________________________________________________ INVESTMENT OBJECTIVE(S): FOR INVESTORS WHO ARE ENTITIES: YEARLY INCOME:____________ NET WORTH:____________ TYPE OF BUSINESS: ___________________________________________________ INVESTMENT OBJECTIVE(S) (FOR ALL INVESTORS): _______________________
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The USA PATRIOT Act. The USA PATRIOT Act is designed to detect, deter, and punish terrorists in the United States and abroad. The Act imposes new anti-money laundering requirements on brokerage firms and financial institutions. Since April 24, 2002 all brokerage firms have been required to have new, comprehensive anti-money laundering programs. To help you understand these efforts, we want to provide you with some information about money laundering and our steps to implement the USA PATRIOT Act. What is money laundering? Money laundering is the process of disguising illegally obtained money so that the funds appear to come from legitimate sources or activities. Money laundering occurs in connection with a wide variety of crimes, including illegal arms sales, drug trafficking, robbery, fraud, racketeering, and terrorism. How big is the problem and why is it important? The use of the U.S. financial system by criminals to facilitate terrorism or other crimes could well taint our financial markets. According to the U.S. State Department, one recent estimate puts the amount of worldwide money laundering activity at $1 trillion a year. What are we required to do to eliminate money laundering? Under rules required by the USA PATRIOT Act, our anti-money laundering program must designate a special compliance officer, set up employee training, conduct independent audits, and establish policies and procedures to detect and report suspicious transaction and ensure compliance with such laws. As part of our required program, we may ask you to provide various identification documents or other information. Until you provide the information or documents we need, we may not be able to effect any transactions for you. Annex D ANTI-MONEY LAUNDERING INFORMATION FORM The following is required in accordance with the AML provision of the USA PATRIOT ACT. (Please fill out and return with requested documentation.) INVESTOR NAME: _________________________________________________________________ LEGAL ADDRESS: _________________________________________________________________ _________________________________________________________________ SSN# or TAX ID# OF INVESTOR: __________________________________________________________________ FOR INVESTORS WHO ARE INDIVIDUALS: YEARLY INCOME: __________________________________ AGE: _____________________________ NET WORTH (excluding value of primary residence): _______________________________________ OCCUPATIONFOR INVESTORS WHO ARE INDIVIDUALS: AGE: ___________________________ NET WORTH: ___________________________________________________________________ ADDRESS OF EMPLOYER* * For purposes of calculating your net worth in this form, (a) your primary residence shall not be included as an asset; (b) indebtedness secured by your primary residence, up to the estimated fair market value of your primary residence at the time of your purchase of the securities, shall not be included as a liability (except that if the amount of such indebtedness outstanding at the time of your purchase of the securities exceeds the amount outstanding 60 days before such time, other than as a result of the acquisition of your primary residence, the amount of such excess shall be included as a liability); and (c) indebtedness that is secured by your primary residence in excess of the estimated fair market value of your primary residence at the time of your purchase of the securities shall be included as a liability. FOR INVESTORS WHO ARE INDIVIDUALS: OCCUPATION: ________________________ ADDRESS OF BUSINESS OR OF EMPLOYER:____________________________________ ___________________________________________________________________________ INVESTMENT OBJECTIVE(S): FOR INVESTORS WHO ARE ENTITIES: YEARLY INCOME:____________ NET WORTH:____________ TYPE OF BUSINESS: ____________________________________ INVESTMENT OBJECTIVE(S) (FOR ALL INVESTORS): ___________________________
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The USA PATRIOT Act. The USA PATRIOT Act is designed to detect, deter, and punish terrorists in the United States and abroad. The Act imposes new anti-money laundering requirements on brokerage firms and financial institutions. Since April 24, 2002 all brokerage firms have been required to have new, comprehensive anti-money laundering programs. To help you understand these efforts, we want to provide you with some information about money laundering and our steps to implement the USA PATRIOT Act. What is money laundering? Money laundering is the process of disguising illegally obtained money so that the funds appear to come from legitimate sources or activities. Money laundering occurs in connection with a wide variety of crimes, including illegal arms sales, drug trafficking, robbery, fraud, racketeering, and terrorism. How big is the problem and why is it important? The use of the U.S. financial system by criminals to facilitate terrorism or other crimes could well taint our financial markets. According to the U.S. State Department, one recent estimate puts the amount of worldwide money laundering activity at $1 trillion a year. What are we required to do to eliminate money laundering? Under rules required by the USA PATRIOT Act, our anti-money laundering program must designate a special compliance officer, set up employee training, conduct independent audits, and establish policies and procedures to detect and report suspicious transaction and ensure compliance with such laws. As part of our required program, we may ask you to provide various identification documents or other information. Until you provide the information or documents we need, we may not be able to effect any transactions for you. MEMBER: FINRA, SIPC ANTI-MONEY LAUNDERING INFORMATION FORM The following is required in accordance with the AML provision of the USA PATRIOT ACT. (Please fill out and return with requested documentation.) INVESTOR NAME: _________________________________________________________________ LEGAL ADDRESS: _________________________________________________________________ _________________________________________________________________ SSN# or TAX ID# OF INVESTOR: __________________________________________________________________ FOR INVESTORS WHO ARE INDIVIDUALS: YEARLY INCOME: __________________________________ AGE: _____________________________ NET WORTH (excluding value of primary residence): _______________________________________ OCCUPATION: ___________________________________________________________________ ADDRESS OF EMPLOYER: ___________________________________________________________ ___________________________________________________________ INVESTMENT OBJECTIVE(S): ________________________________________________________
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The USA PATRIOT Act. The USA PATRIOT Act is designed to detect, deter, and punish terrorists in the United States and abroad. The Act imposes new anti-money laundering requirements on brokerage firms and financial institutions. Since April 24, 2002 all brokerage firms have been required to have new, comprehensive anti-money laundering programs. To help you understand these efforts, we want to provide you with some information about money laundering and our steps to implement the USA PATRIOT Act. What is money laundering? Money laundering is the process of disguising illegally obtained money so that the funds appear to come from legitimate sources or activities. Money laundering occurs in connection with a wide variety of crimes, including illegal arms sales, drug trafficking, robbery, fraud, racketeering, and terrorism. How big is the problem and why is it important? The use of the U.S. financial system by criminals to facilitate terrorism or other crimes could well taint our financial markets. According to the U.S. State Department, one recent estimate puts the amount of worldwide money laundering activity at $1 trillion a year. What are we required to do to eliminate money laundering? Under rules required by the USA PATRIOT Act, our anti-money laundering program must designate a special compliance officer, set up employee training, conduct independent audits, and establish policies and procedures to detect and report suspicious transaction and ensure compliance with such laws. As part of our required program, we may ask you to provide various identification documents or other information. Until you provide the information or documents we need, we may not be able to effect any transactions for you. ANNEX D ANTI-MONEY LAUNDERING INFORMATION FORM The following is required in accordance with the AML provision of the USA PATRIOT ACT. (Please fill out and return with requested documentation.) INVESTOR NAME: _________________________________________________________________ LEGAL ADDRESS: _________________________________________________________________ _________________________________________________________________ SSN# or TAX ID# OF INVESTOR: __________________________________________________________________ FOR INVESTORS WHO ARE INDIVIDUALS: YEARLY INCOME: __________________________________ AGE: _____________________________ NET WORTH (excluding value of primary residence): _______________________________________ OCCUPATIONFOR INVESTORS WHO ARE INDIVIDUALS: AGE: ________________________ NET WORTH: ___________________________________________________________________ ADDRESS OF EMPLOYER* * For purposes of calculating your net worth in this form, (a) your primary residence shall not be included as an asset; (b) indebtedness secured by your primary residence, up to the estimated fair market value of your primary residence at the time of your purchase of the securities, shall not be included as a liability (except that if the amount of such indebtedness outstanding at the time of your purchase of the securities exceeds the amount outstanding 60 days before such time, other than as a result of the acquisition of your primary residence, the amount of such excess shall be included as a liability); and (c) indebtedness that is secured by your primary residence in excess of the estimated fair market value of your primary residence at the time of your purchase of the securities shall be included as a liability. FOR INVESTORS WHO ARE INDIVIDUALS: OCCUPATION: _________________________ ADDRESS OF BUSINESS OR OF EMPLOYER:______________________________________ ______________________________________________________________________________ INVESTMENT OBJECTIVE(S): FOR INVESTORS WHO ARE ENTITIES: YEARLY INCOME: __________ NET WORTH: ___________ TYPE OF BUSINESS: ____________________________________ INVESTMENT OBJECTIVE(S) (FOR ALL INVESTORS): ______________________________
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The USA PATRIOT Act. The USA PATRIOT Act is designed to detect, deter, and punish terrorists in the United States and abroad. The Act imposes new anti-money laundering requirements on brokerage firms and financial institutions. Since April 24, 2002 all brokerage firms have been required to have new, comprehensive anti-money laundering programs. To help you understand these efforts, we want to provide you with some information about money laundering and our steps to implement the USA PATRIOT Act. What is money laundering? Money laundering is the process of disguising illegally obtained money so that the funds appear to come from legitimate sources or activities. Money laundering occurs in connection with a wide variety of crimes, including illegal arms sales, drug trafficking, robbery, fraud, racketeering, and terrorism. How big is the problem and why is it important? The use of the U.S. financial system by criminals to facilitate terrorism or other crimes could well taint our financial markets. According to the U.S. State Department, one recent estimate puts the amount of worldwide money laundering activity at $1 trillion a year. What are we required to do to eliminate money laundering? Under rules required by the USA PATRIOT Act, our anti-money laundering program must designate a special compliance officer, set up employee training, conduct independent audits, and establish policies and procedures to detect and report suspicious transaction and ensure compliance with such laws. As part of our required program, we may ask you to provide various identification documents or other information. Until you provide the information or documents we need, we may not be able to effect any transactions for you. ANTI-MONEY LAUNDERING INFORMATION FORM The following is required in accordance with the AML provision of the USA PATRIOT ACT. (Please fill out and return with requested documentation.) INVESTOR NAME: _________________________________________________________________ LEGAL ADDRESS: _________________________________________________________________ _________________________________________________________________ SSN# or TAX ID# OF INVESTORINVESTMENT OBJECTIVE: ______________________________________________________________________ FOR INVESTORS WHO ARE INDIVIDUALSENTITIES: YEARLY INCOME: __________________________________ AGE: _____________________________ NET WORTH (excluding value of primary residence): _______________________________________ OCCUPATIONTYPE OF BUSINESS: ___________________________________________________________________ ADDRESS OF EMPLOYER: ___________________________________________________________ ___________________________________________________________ INVESTMENT OBJECTIVE(S): ________________________________________________________
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