American International Bank

Registration Form

Business/Entity Information

Business/Entity Name*:

Country of Incorporation*:

TIN/EIN:

Date of Incorporation*: :

Company/Register Number*:

Type of Entity/Business*:

Nature of Business*:

Products and/or Services (Business Description)*:

Operations Start Date*: :

Monthly Income*:

Number of Employees*:

Number of Offices*:

Main Suppliers*:

Address Information

Physical Address*:

City*:

State*:

Country*:

Zip Code*:

Location of the main office*:

Mailing Address

Name:

Address:

Address (2nd Line):

City:

State / Province / Region:

Zip / Postal Code:

Country:

Contact Information

Full name of the contact person:

Email*:

Confirm Email Address*:

Office Phone Number 1*:

Mobile Number*:

Phone Number 2:

Call-Back Number*:

Web Page:

Politically Exposed Persons (PEPs) are individuals who work or have played prominent public functions, for example Heads of State, politicians, senior government officials, judicial or military officials, senior executives of state enterprises and / or important political party officials.

Is this company related to Politically Exposed Persons?*

Yes No

If the answer is Yes, please complete the following details

Full Name:

Country:

Public Position Held:

Information Regarding the Account and Transactions

Purpose of the Account*:

Other:

Initial Deposit Amount (minimum USD $5,000)*:

Source of Funds*:

Other:

Source of Wealth (only if initial deposit exceeds USD $250,000.00)*:

Other:

Approximate monthly amount in USD of incoming electronic/wire transfers*:

Approximate monthly number of incoming electronic/wire transfers*:

Approximate monthly amount in USD of outgoing electronic/wire transfers*:

Approximate monthly number of outgoing electronic/wire transfers*:

From who do you expect to receive electronic/wire transfers? From which countries?

Full Name 1:

Country 1:

Full Name 2:

Country 2:

Full Name 3:

Country 3:

To who do you expect to send electronic/wire transfers? To which countries?

Full Name 1:

Country 1:

Full Name 2:

Country 2:

Full Name 3:

Country 3:

Full name of each shareholder and beneficial owner of the business/coporation

Full Name 1:

Full Name 2:

Full Name 3:

Full Name 4:

Full Name 5:

Full Name 6:

Full name of each designated signer of the account

Full Name 1:

Full Name 2:

Full Name 3:

Full Name 4:

Full Name 5:

Full Name 6:

Security Questions*

Question #1:

Answer #1:

Question #2:

Answer #2:

Question #3:

Answer #3:

Terms & Conditions

I Agree to these Terms & Conditions *

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Registration Form

Business/Entity Information

Address Information

Mailing Address

Contact Information

Politically Exposed Persons (PEPs) are individuals who work or have played prominent public functions, for example Heads of State, politicians, senior government officials, judicial or military officials, senior executives of state enterprises and / or important political party officials.

Information Regarding the Account and Transactions

From who do you expect to receive electronic/wire transfers? From which countries?

To who do you expect to send electronic/wire transfers? To which countries?

Full name of each shareholder and beneficial owner of the business/coporation

Full name of each designated signer of the account

Security Questions*

Terms & Conditions

Please enter the code as displayed*