FlagOne

Individual KYC Amendment Form


Client Information

 

Client Email:     

Client Name:    

Only Fill up Those Details Which Have Change

 

Name and Contact

 

Phone Country code:   

Phone Number:    

 

Address

 

Residing Country:   

Address:   

City/Town:   

Postal Code:   

 

Certificate Identity

 

 

BTC Funding Wallet

 

Wallet Address:   

 

Declaration and Signature

 

I/We declare and confirm the following:

  • have received, read and agreed to comply with and be bound by the Flag One Pte Ltd (FlagOne) Website Terms and Conditions (https://flagone.io/terms) and any other terms and conditions that FlagOne may issue from time to time, and acknowledge that this application is subject to the same;


  • represent and warrant that all information given to FlagOne is true and correct, undertake to inform FlagOne of any change to the information supplied as and when such changes occur, and undertake to provide FlagOne further information and/or documentary evidence in respect to the information given in this application;
  • inform FlagOne within 30 days of any change in circumstances which will cause the information contained herein to become incorrect or incomplete and to provide FlagOne suitably updated self certification form and declaration within 90 days of such change in circumstances 
  • I understand that the information that will be reported to regulatory authority and any regulatory bodies is 
    • Name, address, Identity ID and date of birth
    • the balance or value of the account at the end of the calendar year or at the date it was closed.
    • the gross amount of , dividends, proceeds from redemption or other amounts paid or credited to me or my account during the calendar year.
  • (in the case of individual subscriber(s)) confirm that I/we am/are not an un-discharged bankrupt(s), have not committed any act of bankruptcy within the last 12 months and no bankruptcy order has been made against me/us during that period);

  • (in the case of a corporate subscriber) confirm that we are not insolvent and that no proceedings have been taken, no order has been made and no resolution has been passed for our winding up, judicial management or liquidation or other similar action;

  • acknowledge that FlagOne may receive certain notices in relation to my/our investments and FlagOne may not forward these notices to me/us;

  • consent to disclosure to or by FlagOne of any information in relation to my/our Account to or by any of its affiliates, any person or entity required to facilitate the operation of my/our Account, and/or to comply with all applicable laws, regulations, notices and guidelines;

  • authorise FlagOne to take all actions and do all things which may be required or which FlagOne may, in their absolute discretion, deem necessary to comply with any law, rule or regulation of any authority or jurisdiction;

  • acknowledge that FlagOne may reject any of my/our instructions including, but not limited to, those that are incomplete, unclear or ambiguous, or if my/our signature(s) differ(s) from what was originally provided as a specimen to FlagOne, and FlagOne will not be responsible for any losses that may be suffered by me/us due to such rejection of any of my/our instructions;

  • consent that any communication from FlagOne (including notices, confirmations, Fund reports and transaction statements) may be sent to me/us via secured electronic mail via the Secured Website or via such other methods in circumstances as may be determined by FlagOne from time to time at its sole discretion;

  • acknowledge and take sole responsibility for any investment decisions committed without the benefit of advice from a tax, legal or Financial Adviser and I/we declare that I/we will not hold FlagOne or any of its officers, employees or agents liable in any respect whatsoever for any losses that I/we may suffer as a direct or indirect consequence of my/our own investment decision(s).

  • understand that no liability can be accepted by FlagOne for any legal consequences under the laws of any other country or tax implications that may arise in connection with my/our investment. I/We am/are also responsible for my/our own tax affairs and hereby declare that I/we have not been convicted of any serious tax crimes.

 

For Reference Only

 

Dated:

userID:

 

Leave this empty:

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Signature Certificate
Document name: Individual KYC Amendment Form
lock iconUnique Document ID: 4c827cbd9d93418da8fb5011d956f11d48b80bd4
Timestamp Audit
January 25, 2019 6:32 pm +08Individual KYC Amendment Form Uploaded by Warren Seah - accounts@flagone.io IP 68.3.153.196