Dear Customer,

Customer due diligence is a necessary part of doing business and way of preventing unnecessary harm to either party involved in a transaction. Kindly review carefully and fill in necessary information regarding your general background and source of wealth. Confirm in return by signing at the bottom of this form that the information is complete and accurate.

Personal details:

Title

First name

Middle nameOnly to be entered if shown on the document

Surname

*Date of birthInput example: 30/08/2021

Place of birth

Address

Post Code

Nationality and any former nationalities

Identification type

Identification number

*Identification date of expiryInput example: 30/08/2021

Telephone

Email

Employment status:

Occupation

PEP:

Are you a Politically Exposed Person?(PEP) Or any of your family members have held a political position (past or present) in a National, State or Provincial Government or they are a close associate with a person who has held a political position (past or present) in a National, State or Provincial Government?

Financial Details:

Annual income:

*What is your annual gross income from your employment?Please provide the annual sum in your local currency.

Do you have other source of income such as royalties or inheritance?If so, please give a detailed explanation.

Estimated expenditure:

*What is your expected amount to be spent for play in a months period?

Is your monthly income adequate to cover your expenditure?

*How frequently do you usually visit gambling websites?

Signature

Self (print name)

*Signing dateExample: 30/08/2021

Confirmation

Signature

Please sign this document.

Confirming your details are correct

I hereby declare that the information provided is true and correct and that I have checked it before submitting.

Agreement

I have read and agree to the:

Terms & conditions

&

Privacy policy