(This declaration is to be completed by an individual/firm for whom fiduciary and incorporation services are to be commissioned on behalf of a client).

_____________________________________________________

I/We, the undersigned, hereby declare and confirm that:

•  I/We will request the provision of services marketed by the Caribbean Holding Company Limited Fiduciary Group by or on behalf of any of its, subsidiaries, associates, affiliates and agents or other clients (collectively referred to herein as CHCL), to whom this application is addressed;

•  the beneficial owner(s), trust settlor(s)\beneficiaries, directors, officers or signatories (collectively ‘clients’) of all structures and services requested to be provided by CHCL will have been properly introduced/identified to us, and we will obtain and hold appropriate documentary evidence to this effect prior to requesting services of or through CHCL;

•  neither I/we nor the clients will have been offered or received any legal or taxation advice from CHCL; and

•  to the best of my/our knowledge and belief, the purposes for which structures and services are to be acquired will not include money laundering, terrorist activities, receiving the proceeds of drug trafficking, trading in arms, munitions or other weapons, soliciting funds from the general public, offering investment advice to the general public, the management of investments other than the property of the entity, the operation and administration of collective investment schemes, trading with countries subject to embargo authorised by the Security Council of the United Nations, or for any other purpose which is illegal under the law of the place of incorporation or management or jurisdiction in which the entity is to conduct its affairs.

We enclose the following information required under anti-money laundering codes of practice:

– Copy of our promotional literature.

– Copy of our due diligence procedures.

•  Terms of business with CHCL duly acknowledged.

NAME OF FIRM ( if applicable ):

ADDRESS:

DATE:

SIGNATURE:

 

SIGNATORY NAME:

 

SIGNATURE:

 

SIGNATORY NAME: