1. Full Legal Corporate Name
2. Registered Office Address
7. List any other names by which the Company is known (ie. Trading Names)
8. Is your Company duly authorised and regulated by a government or other authority in your country?
If the location you operate from is not the same as your Registered Office address, please provide the following:
9. Main Place of Business
10. Telephone Number at this location
11. Please provide the address, telephone number and email address of your operational contact
12. Please provide the names of all persons authorised to sign on behalf of the Company
13. Please state any further information that could be relevant to Kimura:
By signing this document, I am hereby certifying and declaring that all of the information provided above is true, accurate, complete and not misleading by error, omission or otherwise. I confirm that I am a duly authorised representative of the Company and I have the authority to sign on behalf of the Company. We undertake to promptly inform Kimura Capital LLP, as permitted by law, of any civil or criminal penalties imposed on the Company that relate to a failing of our AML/CTF responsibilities and obligations. Additionally, we undertake to promptly inform Kimura Capital LLP upon the identification of any blocked persons, individuals or entities, or any beneficial owners relating to any business placed with Kimura. Finally, we undertake to inform Kimura of any other material changes to the information provided within this document. We expressly recognise the right of Kimura to terminate any business or contractual relationship maintained with the Company in view of a Sanction breach or failure to provide information or documentation that may be required by regulatory or legal obligation.
Your full name
Email address of person completing this form