Account Closure Further Information Request This form must be typed. Do not send hand written form. 1 Your Personal details First name Last name Date of birth D D M M Y Y Y Y Email Telephone number Postal Address Passport/ID number Address _________________________________________________________________________________________________ _________________________________________________________________________________________________ City / Country ______________________________________________ Postcode_______________________________ 1-1 Please answer to each and every question clearly in plain English. This form is to comply with Anti Money Laundering Regulations and must be completed by the account owner. Any false information may delay your application and is against the law. Why have you opened an investment account with Unique Finance at the first place? __________________________________________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________________ Why you have decided to close your account? __________________________________________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________________ Who introduced you to the system? _______________________________________________________________________________________________________________________ What is your total annual income (before tax)? _______________________________________________________________________________________________________________________ What is your day job? _______________________________________________________________________________________________________________________ What was the source of the funds you have used to open Unique Finance Account? __________________________________________________________________________________________________________________________________________________________________________________________________ Account Closure – Request for more information – Global Portfolio Management – C9918-12 For official use only 1 Account Closure Further Information Request 2 Your Account details Expert ID S Registered Date P D D M M Y Y Y Y Total Deposit (USD) Total Income (USD) Available Balance (USD) 3 Disposal of Funds To another Expert ID S P To your own Bank Account Account Number Account Name IBAN/SWIFT/SORT CODE Bank Name & Address Other Details (if applicable) Account Closure – Request for more information – Global Portfolio Management – C9918-12 For official use only 2 Account Closure Further Information Request 4 Consent I give my consent for closing my account mentioned above with Unique Finance. I hereby release, indemnify and hold harmless Unique Finance, Global Portfolio Management, the organizers, sponsors, staff, experts, advisors and supervisors of all its activities relating to Unique Finance and Global Portfolio Management from any and all liability in connection with my account with the above details. I understand that I will surrender all my rights if any in relation to this account and Unique Finance, Global Portfolio Management, the organizers, sponsors, staff, experts, advisors and supervisors of all its activities relating to Unique Finance and Global Portfolio Management have no further responsibilities and obligations towards my account or me. I hereby surrender all my right, title and interest in Unique Finance, Global Portfolio Management, the organizers, sponsors, staff, experts, advisors and supervisors of all its activities relating to Unique Finance and Global Portfolio Management. Signed & Dated by the Account Holder Full name: ____________________________________________________________________________________________ Signature: a t t a c h Attach a recent passport size photo a Date: r e c e n t Document checklist: ▢ ▢ ▢ ▢ p a s s p o r t Fill this form completely & put your initials on the bottom of each and every page. s Sign and Date the form. i Attach a recent passport size photograph of account holder. z Attach a notarized & certified copy of passport or ID card. e p h Send documents above to the following address with recorded postal service and keep the receipt for your o records. t o a tUnique Portfolio Management t aOffice 301 cEmirate Atrium Building hAl Wasl, Dubai United Arab Emirates a r e c Account Closure – Request for more information – Global Portfolio Management – C9918-12 e n t For official use only 3
