KNOW YOUR CLIENT FORM | Realty St. Lucia

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REALTY ST. LUCIA CLIENT VERIFICATION FORM

IDENTIFICATION DETAILS

Title *
Mr.MissMrs.MsOther
Full Name *
Date Of Birth *
Place Of Birth *
Nationality *
Marital Status *
Proof Of Identity *

CONTACT DETAILS

Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone Number *
Email Address *

EMPLOYMENT DETAILS

OCCUPATION / PRINCIPAL BUSINESS ACTIVITY: *
EMPLOYER NAME / BUSINESS NAME: *
EMPLOYER/BUSINESS ADDRESS: *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

SOURCE OF FUNDS

SOURCE OF FUNDS TO PURCHASE THE PROPERTY *
By reason of the requirement of the Money Laundering (Prevention) Act, St. Lucia – No.8 of 2010. The Company’s policy requires it to be satisfied as to the source of funds in excess of $10,000.00 XCD before accepting, deposits, funds for conversion, transfer for the purchase of any property. Consent is hereby given to Realty St. Lucia to disclose this information to law enforcement authorities and to seek verification of the source of funds.
I do hereby declare that the above answers are true. *Sign - Enter name
Phone

Verification

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