Onboarding application form for individuals

1. CLIENT DETAILS

FIRST NAME

SURNAME

DATE BIRTH (DD/MM/YYYY)

NATIONAL IDENTITY CARD

PASSPORT NUMBER

LANDLINE PHONE NUMBER

MAIN MOBILE NUMBER

MAIN EMAIL ADDRESS

OCCUPATION

ESTIMATED MONTHLY INCOME

STREET ADDRESS

CITY/TOWN

STATE/PROVINCE

ZIP/POSTAL CODE

VERIFICATION DOCUMENTS

National ID / Passport *

Drag & Drop or Click to Upload

Supported formats: JPG, PNG, PDF (Max 5MB)

Proof of Address *

Drag & Drop or Click to Upload

Supported formats: JPG, PNG, PDF (Max 5MB)

Location Verification

VIDEO VERIFICATION

Please record a video of yourself holding your ID document (Passport or National ID) and speaking your name and date of birth.

2. ASSET DETAILS

What type of assets do you want to invest in ?

TYPE OF ASSET	INITIAL QUANTITY	SOURCE OF FUNDS	ACTION

3. DISCIPLINARY HISTORY AND RELATED MATTERS

If a Client is uncertain about the materiality of a specific disciplinary proceeding or event, the matter should be disclosed in the comments box below.

IF ANSWERED 'YES' TO ANY OF THESE QUESTIONS, PLEASE PROVIDE DETAILS BELOW, ATTACHING RELEVANT DOCUMENTS, IF ANY

Required Documents

NB: If you intend/ or in fact custody or exchange in excess of USD 100,000 worth of assets per year, please note that you will have to provide a Certified Copy of a Bank Reference (less than 3 months old) /6 months Bank Statement (less than 3 months). Failure to do so might result in your account being frozen until the said document is provided.

I confirm that I have read, understood and agreed to the terms and conditions of MINDEX as per our website.

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I confirm that I have read, understood and agreed to the indemnity provision attached.

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I confirm that the information provided above is accurate and true.