Client Information Profile (CIP Form) Client Information Profile Form Application progress Section (1): About You Family Name * Forename(s) * Date of Birth * Nationality * Marital Status - Select from List - Married Divorced Separated Widowed Single If Married: Full Name of Spouse Passport Number Passport Expiry Date Place of Issue Occupation or Profession Number of Dependants Professional Qualifications State of Health * - Select from List - Good Fair Poor Personal Contact Information Your Residential Address * Town * Postal / Zip Code * Country Mobile Number Home Telephone Office Telephone Fax Preferred Telephone * Have you ever been a resident of another country in the past 10 years? * - Select from List - Yes No If Yes: Please state Previous Countries of Residence: Email Address * Good to know All information provided within this CIP form is confidential. This information is requested by law and in compliance with anti- money laundering legislation. Any information that you volunteer in this form will be held in the strictest confidence and will not be disclosed to any third party outside of our identity verification processes. Failure to provide full, correct and true information may lead to refusal of your application. Information given in this form may also help us to provide you with the correct services and facilities and may assist us in identifying products and services that are tailored to your own specific needs and requirements. This information will NOT be filed by any third party and will remain confidential at all times. Fields marked with * are mandatory Need help? Call +41 22 544 1653 firstname.lastname@example.org Next If you are human, leave this field blank.