Customer Due Diligence & Onboarding Form

Customer Due Diligence & Onboarding Form
The personal data collected in this form will be processed by the BlueSpark AG with which the third party proposes to relate, with the purpose of carrying out the Customer Due Diligence (CDD), under the terms described here.

By providing BlueSpark AG with the personal data of its legal representatives, the third party, as the entity responsible for data processing, will comply with the legal duty to inform said holders about the communication of their personal data to BlueSpark AG, and may, for this purpose, deliver them the aforementioned informative document.

Please complete the form and submit it with the associated supporting documentation.

In case of doubts related with the filling of the form, please contact your BlueSpark AG focal point or write to onboarding@bluespark.ch.
A. Company Details
Name of the entity (hereinafter "the Company")*
Legal Status*

Sole ProprietorshipPartnershipLimited PartnershipLimited Liability Company (LLC)Public Limited Liability CompanySpecial purpose Vehicle (SPV)Other
Registered Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Government Office where registered*
Please provide copies of the registration documents and the English translations where applicable.
Company Registration Number*
As reported in commercial registry
VAT Number*
Legal Entity Identifier (LEI)
Principal business activity*
Purpose or nature of transactions to be undertaken with BlueSpark AG*
B. Primary Contact Details
Primary Contact Person*

First NameLast Name
Email*
example@example.com
Direct Number

Country CodeArea CodePhone Number
Office Number

Country CodeArea CodePhone Number
Position*
Address for Correspondence*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
C. Bank Details
Account Name*
Bank Name*
Bank Address*
IBAN*
SWIFT code
Account Number

D. Authorised Signatories
Identify all personnel who have sufficient power to legally sign on behalf of the entity*
E. Ultimate Beneficiary Owners
Please, list below Individuals who are:
1. Board members (full name, nationality and date of birth)
2. Shareholders with more than 25%, direct or indirect ownership
3. Considered to be ultimate beneficial owners
Identify all individual beneficiaries as above*
Please, list below Companies that are:
1. Shareholders with more than 25%, direct or indirect ownership
2. Considered Subsidiaries
Identify all company beneficiaries as above

G. File Upload
Please submit the following documents (Original and English translations where applicable) and mark as attached:

Company Registration (CR) / Business LicenseSigned Bank reference letter / Bank confirmation letterStructure of legal ownershipPassport/National ID copy for each recognized shareholder in (E)Financial Statement for the last yearOther
Cancelof

D. Declaration
I/We hereby confirm that the above information provided to you is true and correct to the best of our knowledge. I / We acknowledge that if the information provided is found to be false or misleading then the business relationship may be annulled anytime at your discretion. I/We hereby agree to provide any additional information/documentation that may be required.
Authorised Signatory*

First NameLast Name
Email*
Designation*
Signature*

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Date Signed

DayMonthYear
Date
For Office Use Only
Type a question

Originals verified and Self-Attested Document copies received
Name of the Authorized Signatory

First NameLast Name
Signature of the Authorized Signatory

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Date Signed

DayMonthYear
Date
Should be Empty:

Customer Due Diligence & Onboarding Form

A. Company Details

B. Primary Contact Details

C. Bank Details

D. Authorised Signatories

E. Ultimate Beneficiary Owners

F. Compliance Questionnaire

G. File Upload

D. Declaration

For Office Use Only