Account Reactivation Form – For Dormant Account 账户重新启动表格

PAGE 1 OF 5
FSM-ARF-20160505
Account Reactivation Form – For Dormant Account
账户重新启动表格
NOTE: Re-performance of Customer Due Diligence is required to activate Dormant Account(s).
Please email us completed forms and supporting documents required for verification. (Please refer to the last page for details).
SECTION 1: ACCOUNT DETAILS 账户资料
⃞
P
Existing Account
⃞
Account Type
⃞
Personal
Beneficiary
SECTION 2: MAIN APPLICANT’S DETAILS 主要申请者资料
Full Name of Main Account Holder (as in NRIC/Passport) 主要账户持有人姓名
Passport/NRIC No.
身份证/护照号码
Date of Birth
出生日期
⃞ Dr ⃞ Mr ⃞ Ms ⃞ Mrs ⃞ Mdm
Country of
Issue 签发国
D
D – M
M –
Y
Y
Y
Y
Gender 性别
⃞
Nationality
国籍
Country of Birth
Race
Do you have a Foreign (other than U.S.) Taxpayer
Identification Number (TIN)?
⃞ Yes ⃞ No
If yes, please specify your TIN number
Singapore Tax Resident 纳税身份
⃞ Yes ⃞ No
If no, please specify your country of tax residency
__________________________________________
_______________________________________
Are you a U.S. Permanent Resident
(Green Card Holder)? ⃞ Yes ⃞ No
Do you have a U.S. Taxpayer Identification Number
(TIN)? ⃞ Yes ⃞ No
If yes, please specify __________________________
Are you a Politically Exposed Person (“PEP”)?
⃞
Male 男 Female 女
⃞ Yes (Please answer all 3 questions below)
⃞ No
“PEP” means a domestic PEP, foreign PEP or international organisation PEP;
"Close associate" means a natural person who is closely connected to a PEP, either socially or professionally;
"Domestic PEP" means a natural person who is or has been entrusted domestically with prominent public functions;
"Family member" means a parent, step-parent, child, step-child, adopted child, spouse, sibling, step-sibling and adopted sibling of the PEP;
"Foreign PEP" means a natural person who is or has been entrusted with prominent public functions in a foreign country;
"International organisation" means an entity established by formal political agreements between member countries that have the status of international treaties, whose
existence is recognised by law in member countries and which is not treated as a resident institutional unit of the country in which it is located;
"International organisation PEP" means a natural person who is or has been entrusted with prominent public functions in an international organisation;
"Prominent public functions" includes the roles held by a head of state, a head of government, government ministers, senior civil or public servants, senior judicial or
military officials, senior executives of state owned corporations, senior political party officials, members of the legislature and senior management of international
organisations.
If you are a PEP, please answer all the questions below.
1. Please indicate the name of your i) organisation / employer and ii) your occupation / position.
If you are not the PEP, please indicate i) the name of that immediate family member(s) or close associate (s) who is, ii) the name of his/her/their
organisation / employer and iii) their occupation / position.
2. Is there any expected receipt of large sums of monies from governmental bodies or state owned entities? If yes, from who / where?
3. Will there be any usage of government account(s) as a source of funds in a transaction?
Contact Details:
Mobile
–
⃞ Pls tick if it is a U.S. number
Home
–
⃞ Pls tick if it is a U.S. number
Office
–
⃞ Pls tick if it is a U.S. number
Email Address
We will send out emails related to your transactions to your email address as indicated above.
Fundsupermart.com is a division of iFAST Financial Pte. Ltd.
iFAST Financial Pte. Ltd. (Company Registration 200000231R) 10 Collyer Quay #26-01, Ocean Financial Centre, Singapore 049315
PAGE 2 OF 5
FSM-ARF-20160505
Account Reactivation Form – For Dormant Account
账户重新启动表格
Residential Address (as in NRIC/Passport) 登记住址
(P.O. Box and V Box are not allowed)
Postal Code
邮区号码
#Level-Unit No.
State
Country
Mailing Address (If different from Residential Address)
⃞ Same as Residential Address
⃞ Different from Residential Address
If your mailing address is different, please note that:
(i) It should not be a P.O. Box address
(ii) A reason for the difference is required, and
(iii) Provide a supporting document to verify your mailing address
Due to the latest regulatory requirements and also to ensure your
statements get sent to your correct mailing address, your mailing address
should ideally be the same as your residential address.
Postal Code
#Level-Unit No.
State
Country
Reason for Different Mailing Address (Please select one)
⃞
⃞
This is my parent’s/child’s/sibling’s/ spouse’s
address
⃞
⃞
This is my office address
This is the address of the rented apartment
that I am staying in
I am currently working/studying overseas
⃞
⃞
This is the address of the other property that
I own
I am currently staying with my friend/ fiance/
fiancee/ spouse
Main Applicant’s Employment Details 主要申请者就业资料
Name of Employer 雇主
Occupation (please tick one) 职业
⃞
Accounting/Finance
⃞
Engineering
⃞
Professional Services
⃞
Consulting
⃞
Executive/Senior Management
⃞
Research & Development
⃞
Unemployed
⃞
Retired
⃞
Government/Military
⃞
Sales/Marketing/Advertising
⃞
Student
⃞
Education/ Training
⃞
Customer Service
⃞
General Admin/ Supervisory
⃞
Manufacturing/Operations
⃞
Others, please specify: _________________________________
⃞
Self-Employed, please specify nature of business: ______________________
Annual Income S$ (please tick one) 年收入
⃞
Less than 30,000
⃞
30,000 - 60,000
⃞
60,001 - 100,000
⃞
100,001 - 150,000
⃞
150,001 - 200,000
⃞
200,001 - 300,000
⃞
Above 300,000
Are you involved / in the business of / employed by the following activities / employers that are:
Money changers; Remittance agents; Pawnbrokers; Internet-based stored value facility holders
⃞ Yes
⃞ No
If Yes, please indicate
Type of Business
Occupation/Position
Source of Funds for Investment 资金来源
⃞
Salary
⃞
Sale of Real Estate
⃞
Business Profits
⃞
Gift/ Inheritance
⃞
Savings
Fundsupermart.com is a division of iFAST Financial Pte. Ltd.
iFAST Financial Pte. Ltd. (Company Registration 200000231R) 10 Collyer Quay #26-01, Ocean Financial Centre, Singapore 049315
PAGE 3 OF 5
FSM-ARF-20160505
Account Reactivation Form – For Dormant Account
账户重新启动表格
SECTION 3. BENEFICIARY ACCOUNT DETAILS 受益人资料
Full Name of Beneficiary Account Holder (as in NRIC/Passport)
受益人姓名
Passport/NRIC No.
身份证/护照号码
Date of Birth
出生日期
⃞ Dr ⃞ Mr ⃞ Ms ⃞ Mrs ⃞ Mdm
Country of
Issue 签发国
D
D – M
M –
Y
Y
Y
Country of Birth
Y
Gender 性别
⃞
⃞
Male 男 Female 女
Nationality
国籍
Race
Do you hav a Foreign (other than U.S.) Taxpayer
Identification Number (TIN)?
⃞ Yes ⃞ No
If yes, please specify your TIN number
__________________________________________
Do you have a U.S. Taxpayer Identification Number
(TIN)? ⃞ Yes ⃞ No
If yes, please specify __________________________
Are you a U.S. Permanent Resident
(Green Card Holder)? ⃞ Yes ⃞ No
Are you a Politically Exposed Person (“PEP”)?
⃞ Yes (Please answer all 3 questions below)
⃞ No
“PEP” means a domestic PEP, foreign PEP or international organisation PEP;
"Close associate" means a natural person who is closely connected to a PEP, either socially or professionally;
"Domestic PEP" means a natural person who is or has been entrusted domestically with prominent public functions;
"Family member" means a parent, step-parent, child, step-child, adopted child, spouse, sibling, step-sibling and adopted sibling of the PEP;
"Foreign PEP" means a natural person who is or has been entrusted with prominent public functions in a foreign country;
"International organisation" means an entity established by formal political agreements between member countries that have the status of international treaties, whose
existence is recognised by law in member countries and which is not treated as a resident institutional unit of the country in which it is located;
"International organisation PEP" means a natural person who is or has been entrusted with prominent public functions in an international organisation;
"Prominent public functions" includes the roles held by a head of state, a head of government, government ministers, senior civil or public servants, senior judicial or
military officials, senior executives of state owned corporations, senior political party officials, members of the legislature and senior management of international
organisations.
If you are a PEP, please answer all the questions below.
1. Please indicate the name of your i) organisation / employer and ii) your occupation / position.
If you are not the PEP, please indicate i) the name of that immediate family member(s) or close associate (s) who is, ii) the name of his/her/their
organisation / employer and iii) their occupation / position.
2. Is there any expected receipt of large sums of monies from governmental bodies or state owned entities? If yes, from who / where?
3. Will there be any usage of government account(s) as a source of funds in a transaction?
Contact Details:
Mobile
–
⃞ Pls tick if it is a U.S. number
Home
–
⃞ Pls tick if it is a U.S. number
Office
–
⃞ Pls tick if it is a U.S. number
Email Address
Fundsupermart.com is a division of iFAST Financial Pte. Ltd.
iFAST Financial Pte. Ltd. (Company Registration 200000231R) 10 Collyer Quay #26-01, Ocean Financial Centre, Singapore 049315
PAGE 4 OF 5
FSM-ARF-20160505
Account Reactivation Form – For Dormant Account
账户重新启动表格
Beneficiary Residential Address (as in NRIC/Passport) 受益人登记住址
Postal Code
(P.O. Box and V Box are not allowed)
#Level-Unit No.
State
Country
BENEFICIARY APPLICANT’S EMPLOYMENT DETAILS 受益人就业资料
Name of Employer 雇主
Occupation (please tick one) 职业
⃞
Accounting/Finance
⃞
Engineering
⃞
Professional Services
⃞
Consulting
⃞
Executive/Senior Management
⃞
Research & Development
⃞
Unemployed
⃞
Retired
⃞
Government/Military
⃞
Sales/Marketing/Advertising
⃞
Student
⃞
Education/ Training
⃞
Customer Service
⃞
General Admin/ Supervisory
⃞
Manufacturing/Operations
⃞
Others, please specify: _________________________________
⃞
Self-Employed, please specify nature of business: ______________________
Annual Income S$ (please tick one) 年收入
⃞
Less than 30,000
⃞
30,000 - 60,000
⃞
60,001 - 100,000
⃞
100,001 - 150,000
⃞
150,001 - 200,000
⃞
200,001 - 300,000
⃞
Above 300,000
Are you involved / in the business of / employed by the following activities / employers that are:
Money changers; Remittance agents; Pawnbrokers; Internet-based stored value facility holders ⃞ Yes
⃞ No
If Yes, please indicate
Type of Business
Occupation/Position
Source of Funds for Investment 资金来源
⃞
Salary
⃞
⃞
Sale of Real Estate
Business Profits
⃞
⃞
Gift/ Inheritance
Savings
SECTION 4: APPLICANT(S) DECLARATION 申请者声明
I/We hereby declare and warrant that the information given in this form submitted to you are complete, true and accurate and that I/we have not wilfully
withheld any material fact/information. I/We shall give iFAST Financial Pte Ltd (“iFAST”) written notice of any change in my/our particulars. By disclosing
my/our personal data, I/we consent to iFAST collecting, using and/or disclosing my/our personal data for the purposes of administering my/our Investment(s)
and Investment Account(s). I/We also consent to iFAST transferring my/our personal data to iFAST related group of companies and/or third party service
providers, suppliers, agents, distributors, fund managers or intermediaries for the above purposes. I/We declare that I/we am/are not undischarged
bankrupt(s), have not committed any act of bankruptcy within the past 12 months and no bankruptcy order has been made against me/us or is/are pending
against me/us during that period. I/We acknowledge that I/we are responsible for my/our own tax affairs and declare that I/we have not committed or been
convicted of any tax crimes. I/We hereby consent to iFAST obtaining information immediately from me/us upon reasonable request, for the purpose of
iFAST’s compliance with the Notices and Guidelines on Prevention of Money Laundering and Countering the Financing of Terrorism. If any information is
found false or misleading, iFAST may reject any of my/our application and/or instructions including but not limited to, any transactional-related activities.
Unless otherwise disclosed in writing, I/ We hereby declare and warrant that I/We am/are the ultimate Beneficial Owner # of this account and that no person
other than myself have or will have any interest in, influence or control over this account, whatsoever.
I/We confirm that I/we have received, read, understood and agreed to be bound by this Application Form, the relevant Investment Account Terms and
Conditions and Fee Schedule.
# Beneficial Owner: A beneficial owner refers to an individual who ultimately owns or has effective control to the funds or assets in the Fundsupermart investment account. Unlike the beneficiary
account holder, the beneficial owner will not inherit the assets if the main account holder passes on.
MAIN Applicant Signature
BENEFICIARY Applicant Signature (only if 21 years old & above)
Date
D
D – M
M –
Y
Y
Y
Y
Date
D
D – M
M –
Y
Y
Y
Y
Fundsupermart.com is a division of iFAST Financial Pte. Ltd.
iFAST Financial Pte. Ltd. (Company Registration 200000231R) 10 Collyer Quay #26-01, Ocean Financial Centre, Singapore 049315
PAGE 5 OF 5
FSM-ARF-20160505
Account Reactivation Form – For Dormant Account
账户重新启动表格
ACCOUNT ACTIVATION SUPPORTING DOCUMENTS REQUIRED
For Singapore Citizen &
Singapore Permanent Resident
1.
2.
3.
For Malaysian &
Other Nationalities
A photocopy of your NRIC – (Both Front and Back)
Photocopy of Supporting Documents (ANY of the following; not more than 3 months old)
a. Latest Telephone/ Internet Bill (Utility bills are not accepted)
b. Latest Bank Statement/ Printed e-Statements
c. Latest CPF - ”My Particulars” Page (can be printed from CPF website)
For Beneficiary Account application (if applicable):
a. A photocopy of your Beneficiary Applicant’s NRIC (both front and back)/ passport.
b. Beneficiary Applicant above 21 years old must also submit his/her photocopy of
Supporting Documents, as above.
1.
2.
A photocopy of your Malaysian Identity Card (IC) – (Both Front and Back)
A copy of your passport
3.
Photocopy of Supporting Documents (ANY of the following; not more than 3 months old)
a. Latest Telephone/ Internet Bill (Utility bills are not accepted)
b. Latest Bank Statement
For Beneficiary Account application (if applicable):
a. A photocopy of your Beneficiary Applicant’s NRIC (both front and back)/ passport.
b. Beneficiary Applicant above 21 years old must also submit his/her photocopy of
Supporting Documents, as above.
4.
IMPORTANT NOTES:
1.
For National Registration Identity Card (NRIC) Holder, address on NRIC MUST match the residential address (as in
NRIC/passport) on the Investment Account Opening Form.
2.
If the Mailing Address on the form is different from your Residential Address (NRIC Address), supporting documents (as
above) MUST match both Name and the Mailing Address stated in the form.
3.
For Passport Holder, address on supporting document must match the residential address on the Investment Account Opening
Form. If you have stated a different mailing address on the form, additional supporting documents are required to reflect the
mailing address.
4.
Please email your signed form and supporting documents to [email protected]
5.
Please contact our Client Services team at +65 6557 2853 or [email protected] if you need further clarification or
assistance. Our Client Services team operates from 9am to 6pm on Mondays to Fridays (excluding public holidays).
For Official Use 内部使用
Account Details Updated by/Date
Dormant Unblocked by/Date
Fundsupermart.com is a division of iFAST Financial Pte. Ltd.
iFAST Financial Pte. Ltd. (Company Registration 200000231R) 10 Collyer Quay #26-01, Ocean Financial Centre, Singapore 049315