Client Information Sheet 客户信息表—曾总资料

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1、昆山淀山湖庄园房地产发展有限公司ClientInformationSheet客户信息表InaccordancewithArticlestwo(2)throughfive(5)oftheDueDiligenceConventionandtheFederalMarketingCommissionCircularofDecember1998,concerningthepreventionofmoneylaundering,thefollowinginformationmaybesuppliedtobanksand/orotherFederalInstitutionsforv

2、erificationpurposes.按照反洗钱法，下列提供给银行和/或联邦机构的信息用于查询用。1)Borrower’sName借方名称：FullNameofBusiness公司名称：BusinessAddress营业地址：BusinessRegistrationNo.营业执照号码：RegisteredAddress注册地址：Telephone电话号码：Facsimile传真号码：E-MailAddress电子邮件号码：2）Signatory’sInformation签字人资料FullName姓名：Nationality国籍：PassportNo.护照号码：Pas

3、sport-IssuingCountry护照签发国：5DateifIssue护照签发日期：PlaceofIssue护照签发地：DateofExpiration护照到期日：DateofBirth出生年月日：PlaceofBirth出生地：SSN/NationalIdentityNo.身份证号码：HomeAddress家庭住址：HomeTelephone家庭电话：MobileTelephone移动电话号码：Facsimile家庭传真号码:E-MailAddress(personal)个人电子邮件：3）LegalRepresentative法律顾问CounselFullNa

4、me法律顾问姓名:LawFirmName律师事务所名称：Address律师事务所地址：Telephone律师事务所电话：Facsimile律师事务所传真：E-mailAddress律师事务所电子邮件：4）Borrower’sPayingBank5借方付款银行NameofBank银行名称：BankAddress银行地址：AccountName账户名称：Account/Signatory账户签字人：AccountNo.账号：BankOfficer银行官员：Telephone银行电话：Facsimile银行传真：E-mailAddress银行电子邮件：S.W.I.F.T.C

5、ode银行SWIFT代码：ABACode汇款ABA代码5）Borrower’sReceivingBank借方接证银行NameofBank银行名称：BankAddress银行地址：AccountName账户名称：Account/Signatory账户签字人：AccountNo.账号：BankOfficer银行官员：Telephone5银行电话：Facsimile银行传真：E-mailAddress银行电子邮件：S.W.I.F.T.Code银行SWIFT代码：ABACode汇款ABA代码6）FundsofInformation资金信息Origin资金来源：AreFunds

6、cleanandclear?资金是干净、清洁的吗？7）BankReadiness银行准备MyBankisawareofthisYES知道/NO不知道.[alsotransactionenterthenameofthebank也要在此写上银行名称]我的银行知道此交易NameofBankOfficer银行官员：Contactinfo[emailaddressandtelephone联系信息：number银行官员电子邮件和电话号码]7）BriefDescriptionofCorporateActivities公司业务活动简述：Declaration声明：Iherebyswe

7、arunderpenaltyofperjury,thatthe5informationprovidedisbothtrueandaccurate.Iamthesignatoryontheaforementionedbankaccount.Allmoniesengagedinthistransactionarederivedfromnon-criminalorigin;and,aregood,cleanandcleared.TheoriginoffundsisincompliancewithAnti-Money-LaunderingPoliciesas