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Buyer’s Transaction Code:

To    :  Striker Gold Corporation –Las Vegas Nevada USA

Date: 

 The following undertaking is provided by ____________________, as verification of my identity as defined and described in Articles 2 thru 5 of the Due Diligence Convention, the Federal Banking Commission Circular of December 1991, which deals with the prevention of money laundering, and Article 305 of the Swiss Criminal Code.  The nature and origin of the funds owned by me or the corporate entity under my control are forthrightly and honestly described and defined herein.  The preparer of this information sheet requests all recipients of this document to affirm to protect the confidentiality of the information which follows:

Complete Signatory Name   :                                           

National Origin              :                             

Passport Number                   :                              

Issuance Date                 :                               

Date of Birth                  :                                  

Home Address                :

                                            

                                                                                                              

Home Country               :                                   

Personal Email Address      :                               

Business Email Address        :                          

Home Phone Number          :

Personal Mobile Phone No.  :

Personal Fax Number          :                       

Business Phone Number     :

Business Direct Line           :  

Business Fax Number         :   

Email Address                :  

Business Name               :

Business Address           : 

                                            

                                            

Position or Title             :  

Nature of Business         :   

Registration Number           :  

                                              

Legal Advisor                 :

Legal Advisor Address         :

                                            

                                                      

Bank Name              :

Bank Address                     :

Account Holder Name         :  

Account Number            : 

SWIFT  Code                       :

ABA Routing                       :

 

 

 

Custodial Bank Information

 

Name of Bank                     : 

Bank Address                     :

                                            

                                              

Bank Officer                       :                                                                             

Bank Phone                        :

Bank Facsimile                   : 

Bank e-mail                        :  

 

Are you fluent in English? ____ Yes  ____ No

If not, what is your primary language? ____________________

/s/__________________________________

Name:

Title:

Passport Number:                             

Country Origin:                           

Exp. Date: