Customer questionnaire (private)

08.07.2019.

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Customer details

Name *

Kārlis

Surname *

Johansons

Phone No. *

I accept to receive advertisment messages on my mobile phone

Residence address *

Country *

City/Region *

Village/district *

Village/Street/Number *

Zip code *

Mailing address

Mailing address the same as Residence address

Country

City/Region

Village/district

Village/Street/Number

Zip code

Place of birth (country) *

Citizenship (country) *

Add country

Country for tax residence *

Tax identification number *

Add country

Is the account used to execution of transaction on behalf of any third parties? *

Yes No

Politically exposed person (PEP) *

Source of income

Salary

Pension/allowance

Self-employed

Income from dividends

Income from real estate management

Other

Transactions with dnb

Number of transactions (average, monthly) *

Approximate monthly turnover (EUR/month) *

Approximate monthly cash-in amount (EUR/month) *

Source of funds:

Approximate monthly cash withdrawal amount (EUR/month) *

Purpose of cash withdrawal:

Dnb group

DNB Group customer?

Yes No

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