First Name

Middle Name

Surname

Date of birth (dd/mm/yyyy)

Place of birth

Nationality (if dual state all)

Residential address

Name / House number

Street

Town / City

Parish/County/State

Country

Postcode

Telephone number

Mobile number

Email address

Type of work your are engaging Parslows to do (the "Engagement)

Your Employment | Job title (please provide name of Employer/company and your position. If retired please provide details of last employment.)

Your business activities (If you work outside Jersey please state countries you work in and for what reason)

Your source of funds (Please explain where you obtained the funds for this Engagement)

Your source of wealth (Please provide a description fo your source of wealth (i.e. how and where your overall wealth has been generated e.g. employment, inheritance etc.))

Sanction - if you have international business activities please select "Confirmation" to confirm businesses do not trade with any Sanctioned individual or jurisdiction - otherwise please select "not applicable".
If you do trade with sanctioned jurisdictions please provide a copy of the relevant license to do so.
ConfirmedNot applicableLicesnse attached (certified copy)

How did you hear about Parslows?

WebsiteSocial MediaReputationRepeat BusinessReferalRadio 103Liberty BusChamber NewsletterAgent

Bank Account

Please note that funds must flow through this account and we will only pay out to this account (otherwise we are required to carry out further due diligence).

Name of account holder

Bank name

Branch Address

Sort code

Account number

Do you or any of your immediate family or associates hold (or have you or they ever held) a position as head of state or senior head of state or senior positions in any branch of any government, political party, judiciary, state-owned organisations or armed forces anywhere in the world?
YesNo

If yes - provide details