COMPLIANCE FORM

As required by the Financial Intelligence Centre Act (FICA), and in line with the Electronic Communications and Transactions Act (ECTA) for digital processing and storage.

Client information

Full Name / Registered Company Name:

Trading Name (if applicable)

Identification / Registration Number:

Date of Birth / Incorporation:

Income Tax Number (if applicable):

Nationality / Country of Incorporation:

Residential / Registered Address:

Postal Address:

Contact Number(s):

Email Address:

Occupation / Nature of Business:

VERIFICATION DOCUMENTS (TO BE UPLOADED)

Please upload clear and valid copies of the following documents as required under FICA. All documents must be legible and current (not older than 3 months, where applicable):

For Individuals:

Certified copy of South African ID / Passport (foreign nationals)
Proof of residential address (e.g. utility bill, bank statement, lease agreement)
Proof of income / employment (payslip or bank statement, if applicable)

For Legal Entities (Companies, Trusts, etc.):

Company registration documents (CIPC certificate)
Proof of business address
Company resolution authorising signatory
Certified ID copies of all directors / members / trustees
Proof of tax number / VAT registration (if available)
Recent bank statement (not older than 3 months)

Upload All Documents Below

Certified copy of South African ID / Passport

Proof of residential address

Proof of income / employment

CIPC certificate

Proof of business address

Company resolution authorising signatory

Certified ID copies of all

Proof of tax number / VAT

Recent bank statement

Name

Date

Please Sign Here