OnLine CIS / KYC - PROYTEC PANAMA CORP

The CIS / KYC must be filled in all mandatory fields marked with a red asterisk.

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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.

ELECTRONIC CIS KYC

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USER

!!! DO NOT MODIFY !!!

If you accidentally delete this field you will not be able to submit the form and will have to reload it to fill it out.

PROYTEC PANAMA CORP - PROYTEC GROUP

WRITE EVERYTHING WHIT CAPS LOK

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THE FIELDS WITH A RED ASTERISK ARE MANDATORY

Date

1. NAME and SURNAME
First
Last

2. BUSINESS NAME

3. E-mail for Contact

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 !!!

PERSONAL DATA
PERSONAL DATA

4. Nationality

5. Document

6. If Document is "Other" (description)

7. Document No

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

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

10. Issued by

11. Country of Issuance

12. Personal Tax Code

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

14. Place of Birth (City and State)

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

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

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

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

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

20. Personal Email

BUSINESS DATA
BUSINESS DATA

21. Title and Position (select an item)

22. Business Information (select an item)

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

24. SUBMISSION OF THE APPLICATION
RESERVED for APPLICATION

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

27. Register No

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

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

30. 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 WRITE "-"

31. Business TAX Number

32. Business VAT Number
-> IF THE "VAT Number" MATCHES THE"TAX Number", COPY THE "TAX Number"

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

34. Business E-mail

35. Website

36. 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

BANK DATA
BANK DATA

45. BANK NAME

46. Bank Agency or Branch

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

48. Account Name

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

50. Account No

51. International Banking Circuits
SWIFT
CIPS
Both

52. Swift Code

53. Cips Code
-> IF THE BANK DOES NOT USE THE CIPS CIRCUIT, WRITE "0"

54. Territorial Code
IBAN
ABA
Other
-> AMONG OTHERS:
BSB (Australia and New Zealand), CLABE (Mexico), CTN (Canada), HKBC (Hong Kong), IFSC (India), NUBAN (Nigeria), SBC (Singapore), SC (UK and Ireland), NRN (Other Countries)

55. Territorial Code No
->IF THE BANK USES ANOTHER CODE OR DOES NOT USE "Territorial Code", WRITE THE "Account Number"

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

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

58. Bank Officer E-mail

59. I undertake to send a color copy of the PERSONAL DOCUMENT (indicated in point 5.) 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 5.)

!!! Without this document the CIS/KYC is trashed !!!

60. I undertake to send a copy of the CERTIFICATE OF ESTABLISHMENT of the BUSINESS NAME (indicated in points 2.) 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 2.) - CERTIFICATE OF ESTABLISHMENT

!!! Without this document the CIS/KYC is trashed !!!

STATEMENTS
STATEMENTS

99. 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

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

101. 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

102. 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

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

104. 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.

AUTHORISATIONS
AUTHORISATIONS

105. 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

106. 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

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

108. 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

RESPONSIBILITIES
RESPONSIBILITIES

109. 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

110. COMPILING AND SENDING THE CIS / KYC
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.

111. SEND THE CIS / KYC
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.

112. SIGNATURE
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.

REFERENCE REGULATIONS
REFERENCE REGULATIONS

113. EDT (ELECTRONIC TRANSMISSIONS OF DOCUMENTS)
This CIS / KYC is subject to the rules and regulations of the Electronic Transmission of Documents (EDT), provided that it is sent and received via the indicated email addresses. In particular, signatures on documents transmitted via EDT tools are subject to EDT (Electronic Transmissions of Documents) and will be considered valid and applicable with respect to any provision of this CIS / KYC.

114. ELECTRONIC SIGNATURE
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).

115. ELECTRONIC DOCUMENTS
Electronic Commerce Agreement (ECE/TRADE/257, Geneva, May 2000) adopted by the United Nations Centre for Trade Facilitation and Electronic Business (UN/CEFACT).

116. DATA PROTECTION
EDT documents shall be subject to General Data Protection Regulation (GDPR/UE/2016/679), as applicable.

117. ORIGINAL COPY OF DOCUMENTS
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

DATA (USER)
!!! DO NOT MODIFY !!!

Contact via

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

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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