Individual profile form (NS2) First Name *Middle NameSurname (include maiden) *Date of birth *Nationality **If dual state allResidential Address *AlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelgiumBelizeBeninBermudaBhutanBoliviaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiCabo VerdeCambodiaCameroonCanadaCayman IslandsChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Republic of theCook IslandsCosta RicaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuyanaHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLesothoLiberiaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMoroccoMozambiqueNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaZambiaTelephone number *Mobile number *Email Address *How did you hear about Parslows?WebsiteSocial MediaReputaionRepeat BusinessReferralRadio 103Liberty BusChamber NewsletterAgentBank AccountName of account holder *Bank Name *Sort Code *Account Number *Verification DocumentsParslows will require the documents set out below. These documents are required to verify your identity.Please provide one of the following. Tick beside document provided and return with this form (no requirement for document to be certified).Copy of your current passportCopy of your current national identitiy card (bearing a photograph of you)A copy of your driving licence (bearing a photo of you)Upload identity verification *Choose FileNo file chosenDelete uploaded fileVerification of addressPlease provide one of the following and tick beside the document provided (must be dated within three months - no requirement for document to be certified)Copy of a utility billCopy of a bank statementCopy of government department/ agency/ tax office correspondenceTenancy contract or agreementUpload address verification *Choose FileNo file chosenDelete uploaded fileI understand and accept that any information and or documentation I provide to Parslows in connection with the legal engagement by their client(s) may be subject to disclosure and or production pursuant to orders having legal effect in Jersey. Moreover, pursuant to anti-money laundering laws and or court proceedings, in certain circumstances Parslows may be required to disclose information and or documentation concerning me to third parties such as, but not limited to, banks providing services to such client(s) and/or to intermediaries. I indemnify Parslows for any responsibility and or liability arising directly and or indirectly as a result of such disclosure.I consent to the disclosure of information and or documentation as set out above. Individual Profile Form - NS2 SubmittedYesSubmitPlease do not fill in this field.