Customer Due Diligence – Melody Corporate House

Company No.

(EX: 167687656789 (1265789-H)

Client Entity Name

ABC SDN. BHD.

Personal Information

(Please complete all fields below)

Your capacity in the Client Entity

Ultimate beneficial owner (holding %shares)

Director

Person acting on behalf of the Client Entity

Others (please specify)Others (please specify)

Last name

Given name(s)

Gender

Male

Female

Date of birth

Nationality/Nationalities (if any)

Tax Identification number (if any)

Residential address

City

State/Province

Zip/Postal

Country

Mailing address (If different from residential address)

City

State/Province

Zip/Postal

Country

Email address

Contact Number

(home/office/mobile)

Source of wealth

Family wealth / inheritance (please provide relevant details

Business income (please provide relevant details)

Employment (please provide relevant details)

Investment income (please provide relevant details)

Sales of assets (please provide relevant details)

Gift (please provide relevant details)

Other (please specify and provide relevant details)Other (please specify and provide relevant details)

(Please ✓ as applicable (you may select multiple boxes))

Relevant Details

Section Buttons

Employment Information

Occupation

Name of employer

Nature of Business

If you are self-employed, please provide: Nature of Self-employment:

Purpose of Transaction

Section Buttons

Documents

(Please provide original or certified copies (Note 1) of the following (please ✓ as applicable)

For Malaysia permanent residents, a valid MyKad card

For non-residents, a valid travel document (biodata page), or a valid national (i.e. issued by government) identity card / driving licence bearing your photograph

For a person acting on behalf of the Client Entity, a written authorisation letter issued by the Client Entity, together with (1) or (2) above.

File Upload

Section Buttons

Name

Signature

Date

Confirmation

I am aware of the terms and conditions, and hereby confirm that:

I have no criminal record;

I am not involved in any criminal convictions, fraud, extortion, drug trafficking, corruption, embezzlement, money laundering and/or terrorist financing issues, and my wealth is not derived from any criminal activities but is derived as detailed above;

no step has been taken or no legal proceedings have been started for my bankruptcy or for the appointment of a receiver or administrator over my assets;

I am acting in a personal capacity and not on behalf of any third party; and

Section Buttons