OnLine CIS / KYC - PROYTEC PANAMA

The CIS/KYC must be filled in all mandatory fields marked with a red asterisk.
The system automatically rejects incomplete requests, spam and blocks hacking attempts.

By sending this message I confirm and certify that the information provided below is complete and correct and I authorize its use for the purposes indicated.

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Date *

In accordance with Articles 2 through 5 of the Due Diligence Convention and the Federal Banking Commission Circular of December 1998, and under the US Patriot Act of 2002, as amended in February 2003 concerning the prevention of money laundering and 305 of the Swiss Criminal Code, the following information may be supplied to Banks and/or other Financial Institutions for purposes of verification of identity and activities of the Client described below, and the nature and origin of the funds which are to be utilized. The foregoing is subject to agreement by all parties to whom this information is provided that they are obligated to respect the privacy rights of the Client and all individuals described herein, as well as the generally accepted professional standards relating to the maintenance of confidential information, and to take all appropriate precautions to protect the confidentiality of the information contained herein, This legal obligation shall remain in full force indefinitely without restriction

!!! DO NOT MODIFY !!!

THE FIELDS WITH A RED ASTERISK ARE MANDATORY

1. NAME and SURNAME
First
Last

2. Nationality

3. Document

4. Document No

5. If Document is "Other" (description)

6. Date of issue (Format : dd/mm/yyyy)

7. Date of expiry (Format : dd/mm/yyyy)

8. Issued by

9. Country of Issuance

10. Personal Tax Code

11. Date of Birth (Format : dd/mm/yyyy)

12. Place of Birth (City and State)

13. Personal Residence Address (FULL : Address - City - ZIP code - State)

14. Does the Domicile coincide with the Residence ?
YES
NO

15. Personal Domicile Address (FULL : Address - City - ZIP code - State)
-> COMPLETE IF YOUR DOMICILE DOES NOT COINCIDE WHIT YOUR RESIDENCE (FULL)

16. Personal Home Telephone (Format : +___-___-________)
-> IF YOU DO NOT HAVE A LANDLINE LINE, WRITE "0"

17. Personal Cell Phone (Format : +___-___-________)

18. Personal Email

19. BUSINESS NAME

20. Title and Position (select an item)

21. Business Information (select an item)

22.If Business Information is "Other" (description)

23. SUBMISSION OF THE APPLICATION
RESERVED

24. Business Activity (multiple options are also possible)
Agriculture, Farming, Fishing
Catering, Food, Drinks
Constructions
Communications
Education, Training
Energy
Entertainment
Financial
Health and Social Care
Handicraft
Insurances
Manufacturing
Mining
Professional services
Real Estate activities
Reciclyng
Research and Development
Tourism
Trade
Transport, Shipping
Other (describe below)

25. If Business Activity is "Other" (description)

26. Register No

27. Registration Date (Format : dd/mm/yyyy)

28. Registered Office (FULL : Office - Address - City - ZIP code - State)

29. Operational Headquarters (FULL : Address - City - ZIP code - State)
-> IF THE OPERATIONAL OFFICE IS THE SAME REGISTERED OFFICE, COPY THE ADDRESS OF THE REGISTERED OFFICE
-> IF THE ACTIVITY IS CARRIED OUT OFFSHORE PUT "-"

30. Business TAX Number

31. Business VAT Number
-> IF THE VAT NUMBER MATCHES THE TAX NUMBER, COPY THE TAX NUMBER

32. Business Landline Telephone (Format +___-___-________)

33. Business E-mail

34. Website

35. LEGAL ADVISOR
YES
NO

36. Legal Advisor Name (Name and Surname)
First
Last

37. Legal Advisor Address (FULL : Address - City - ZIP code - State)

38. Legal Advisor Telephone (Format : +___-___-________)

39. Legal Advisor E-mail

40. ACCOUNTING AUDITOR
YES
NO

41. Accounting Auditor Name (Name and Surname)
First
Last

42. Accounting Auditor Address (FULL : Address - City - ZIP code - State)

43. Accounting Auditor Telephone (Format : +___-___-________)

44. Accounting Auditor E-mail

45. BANK NAME

46. Bank Agency or Branch

47. Bank Address (FULL : Address - City - ZIP code - State)

48. International Banking Circuits
SWIFT
CIPS
Both

49. Swift Code

50. Cips Code

51. Account No

52. Iban / Aba No
-> IF THE BANK DOES NOT USE IBAN OR ABA, WRITE THE ACCOUNT NUMBER

53. Account Name

53. Account Signatory Name (Name and Surname)
First
Last

54. Bank Officer Name (Name and Surname)
First
Last

55. Bank Officer Telephone (Format : +___-___-________)

56. Bank Officer E-mail

57. I undertake to send a color copy of the PERSONAL DOCUMENT (indicated in point 3.) to the following e-mail address of PROYTEC PANAMA CORP
Passport
Identity Card
Driving Licence
Other

!!! IMPORTANT !!!

Send the document in JPG or PNG graphic format, not PDF, to e-mail :

proytecbox@gmail.com

The SUBJECT of the email must be:

[NAME and SURNAME] (indicated in point 1.) - [PERSONAL DOCUMENT] (indicated in point 3.)

Without this document the CIS/KYC is trashed

58. I undertake to send a copy of the CERTIFICATE OF ESTABLISHMENT of the BUSINESS NAME (indicated in points 18.) to the following e-mail address of PROYTEC PANAMA CORP
YES

!!! IMPORTANT !!!

Send the document in JPG or PNG graphic format, not PDF, to e-mail

proytecbox@gmail.com

The SUBJECT of the email must be:

[NAME and SURNAME] (indicated in point 1.) - [BUSINESS NAME] (indicated in point 18.) - CERTIFICATE OF ESTABLISHMENT

Without this document the CIS/KYC is trashed

94. I, under penalty of perjury, with full corporate and individual responsibility, hereby irrevocably, confirms neither I, nor anyone else associated with my organization, company or individual investor works for any agency of any government
YES

95. I, under penalty of perjury, with full corporate and individual responsibility, also declare that it is not involved in any government entrapment operation
YES

96. I, under penalty of perjury, with full corporate and individual responsibility, hereby irrevocably, confirm that neither I, nor anyone else associated with my organization or company has been convicted of a crime, in any country in the World
YES

97. I, under penalty of perjury, with full corporate and individual responsibility, also declare that, as nor my team within my organization or company are considered terrorists or on a checklist of the Department of Security of any State in the World
YES

98. I, under penalty of perjury, with full corporate and individual responsibility, declare that
I am not a politically exposed person

99. I, under penalty of perjury, with full corporate and individual responsibility, declare that
I do not have a family member, and that I am not closely related to a politically exposed person

100. I authorize the collection, use and disclosure by PROYTEC GROUP and PROYTEC PANAMA CORP. of the data and information provided with this CIS/KYC, to its affiliates, Credit Agencies, Reporting Agencies, Banking and Financial Institutions and associated Companies
YES

101. I also authorize the disclosure by these parties of credit and financial information obtained from the above sources for the purpose of obtaining and using a credit information report and verifying current and ongoing creditworthiness
YES

102. I understand and accept that PROYTEC GROUP and PROYTEC PANAMA CORP. may disclose personal, business, financial and credit information submitted with this CIS/KYC to future creditors and banking and financial institutions requesting credit references
YES

103. I authorize the collection, use and disclosure of personal information by PROYTEC GROUP and PROYTEC PANAMA CORP. and of the persons (natural and legal) referred to in this CIS/KYC and in the Documents sent
YES

104. I swear under penalty of perjury, with total personal responsibility, that the information provided in this document is accurate and truthful and I irrevocably confirm that I am legally authorized to sign this CIS / KYC also by committing the Company
YES

105. I am aware that this CIS / KYC is filled in directly on the PROYTEC PANAMA CORP website (https://proytecpanama.com) in the DOWNLOAD section from which you access the ONLINE CIS / KYC and is automatically sent when you press the SEND button
YES

106. By pressing the SEND button I accept all the conditions indicated in the form which will be stored electronically and used for recognition purposes in order to be able to use one or more services offered by the PROYTEC GROUP and PROYTEC PANAMA CORP
YES

107. My NAME and SURNAME, which I report again at the end of this CIS / KYC document, must be considered as an electronic signature made by me with the precise, firm and responsible desire to confirm everything I have declared.
I CONFIRM that my NAME and SURNAME, which I report again at the end of this CIS / KYC document, must be considered as an electronic signature made by me with the precise, firm and responsible desire to confirm everything I have declared

108. I am aware that :
EDT (ELECTRONIC DOCUMENT TRANSMISSIONS) This CIS / KYC is subject to the rules and regulations of electronic document transmission (EDT), provided that it is sent and received by the indicated emails. In particular, signatures on documents transmitted through EDT tools are subject to EDT (Electronic Document Transmissions) shall be deemed valid and enforceable in respect of any provisions of this Contract. As applicable, this agreement shall be :
1. Incorporate U.S. Public Law 106-229, ‘‘Electronic Signatures in Global and National Commerce Act’’ or such other applicable law conforming to the UNCITRAL Model Law on Electronic Signatures (2001)
2. Electronic Commerce Agreement (ECE/TRADE/257, Geneva, May 2000) adopted by the United Nations Centre for Trade Facilitation and Electronic Business (UN/CEFACT)
3. EDT documents shall be subject to European Community Directive No. 95/46/EEC, as applicable. Either Party may request hard copy of any document that has been previously transmitted by electronic means provided however, that any such request shall in no manner delay the parties from performing their respective obligations and duties under EDT instruments

ELECTRONIC SIGNATURE (Name and Surname)
First
Last

Email

Customer
!!! DO NOT MODIFY !!!

Contact via

Indicate the Manager or Agent or Partner Company or Customer
IF "Contact via" IS "Website" PUT "-"

It is advisable to be accompanied, advised and supported by a Director, a Manager or an Agent of PROYTEC PANAMA Corp.

Requests from the PROYTEC PANAMA Corp. network take precedence, even if all requests are parsed successfully.

END CIS / KYC

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