инвестиция

Account Closure Further Information Request
This form must be typed. Do not send hand written form.
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Your Personal details
First name
Last name
Date of birth
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D
M
M
Y
Y
Y
Y
Email
Telephone number
Postal Address
Passport/ID number
Address
_________________________________________________________________________________________________
_________________________________________________________________________________________________
City / Country ______________________________________________ Postcode_______________________________
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Please answer to each and every question clearly in plain English. This form is to comply with Anti Money
Laundering Regulations and must be completed by the account owner. Any false information may delay your
application and is against the law.
Why have you opened an investment account with Unique Finance at the first place?
__________________________________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________________
Why you have decided to close your account?
__________________________________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________________
Who introduced you to the system?
_______________________________________________________________________________________________________________________
What is your total annual income (before tax)?
_______________________________________________________________________________________________________________________
What is your day job?
_______________________________________________________________________________________________________________________
What was the source of the funds you have used to open Unique Finance Account?
__________________________________________________________________________________________________________________________________________________________________________________________________
Account Closure – Request for more information – Global Portfolio Management – C9918-12
For official use only
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Account Closure Further Information Request
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Your Account details
Expert ID
S
Registered Date
P
D
D
M
M
Y
Y
Y
Y
Total Deposit (USD)
Total Income (USD)
Available Balance (USD)
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Disposal of Funds
To another Expert ID
S
P
To your own Bank Account
Account Number
Account Name
IBAN/SWIFT/SORT CODE
Bank Name & Address
Other Details (if applicable)
Account Closure – Request for more information – Global Portfolio Management – C9918-12
For official use only
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Account Closure Further Information Request
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Consent
I give my consent for closing my account mentioned above with Unique Finance. I hereby release, indemnify and hold harmless
Unique Finance, Global Portfolio Management, the organizers, sponsors, staff, experts, advisors and supervisors of all its activities
relating to Unique Finance and Global Portfolio Management from any and all liability in connection with my account with the above
details. I understand that I will surrender all my rights if any in relation to this account and Unique Finance, Global Portfolio
Management, the organizers, sponsors, staff, experts, advisors and supervisors of all its activities relating to Unique Finance and
Global Portfolio Management have no further responsibilities and obligations towards my account or me. I hereby surrender all my
right, title and interest in Unique Finance, Global Portfolio Management, the organizers, sponsors, staff, experts, advisors and
supervisors of all its activities relating to Unique Finance and Global Portfolio Management.
Signed & Dated by the Account Holder
Full name: ____________________________________________________________________________________________
Signature:
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Attach a recent passport size photo
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Date:
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Document checklist:
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Fill this form completely & put your initials on the bottom of each and every page.
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Sign and Date the form.
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Attach a recent passport size photograph of account holder.
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Attach a notarized & certified copy of passport or ID card.
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Send documents above to the following address with recorded postal service and keep
the receipt for your
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records.
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o
a
tUnique Portfolio Management
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aOffice 301
cEmirate Atrium Building
hAl Wasl, Dubai
United Arab Emirates
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Account
Closure – Request for more information – Global Portfolio Management – C9918-12
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For official use only
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