KNOW YOUR CLIENT FORM

Title *

Mr.MissMrs.MsOther

Full Name *

Date Of Birth *

Place Of Birth *

Nationality *

Marital Status *

Proof Of Identity *

Identity Number *

Address

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Phone Number *

Email Address *

OCCUPATION / PRINCIPAL BUSINESS ACTIVITY: *

EMPLOYER NAME / BUSINESS NAME: *

EMPLOYER/BUSINESS ADDRESS: *

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

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.

How are you paying? *

CashMortgageOther

Time Frame For Purchasing *

Do you require Alien Land Holding Licence? *

YesNoMaybe

I do hereby declare that the above answers are true. *Sign - Enter name

Phone