American International Bank

Registration Form

Personal Information

Name*:

Second Name:

Last Name(s)*:

Second Last Name:

Date of Birth*: :

Nationality (Country of Birth)*:

Do you have a U.S. Tax Identification Number?

Yes No

If the answer is Yes, please provide the number:

Country of Current Location*:

Civil Status:

Occupation*:

Industry of Occupation*:

Type of Identification 1

Type of Identification 1*:

Specify:

Issue Date*: :

ID Number*:

Expiration Date*: :

Country of Issuance*:

Type of Identification 2

Type of Identification 2*:

Specify:

ID Number*:

Issue Date*: :

Expiration Date*: :

Country of Issuance*:

Address Information

Physical Address*:

Address (2nd Line):

City*:

State*:

Country*:

Zip Code:

Mailing Address

Name:

Address:

Address (2nd Line):

City:

State / Province / Region:

Zip / Postal Code:

Country:

Contact Information

Email*:

Confirm Email Address*:

Home Phone Number:

Office Phone:

Mobile Number*:

Fax:

Employment Information

Employee*

Yes No N/A

Director/Business Owner

Yes No N/A

Unemployed*

Yes No N/A

Professional Service Provider (Independent)*

Yes No N/A

Retired*

Yes No N/A

Do you receive a retirement pension?*

Yes No

If the answer is yes , please explain:

Employer/Company Name:

Position in Company:

Monthly Salary*:

Monthly Salary Currency:

Monthly Salary in USD:

Years in Employment/Company:

Employment Physical Address:

City:

State:

Country:

Zip Code:

Do you have any other income?

Yes No

Monthly Amount of Other Income:

Other Income Description:

Currency of other income:

Amount in USD of Other Income:

Politically Exposed Person (PEP): Are any of the account holders, signatories, or their immediate family members (parents, siblings, spouse, children, & or in-laws); a current or former senior official in the executive, legislative or administrative arms of government, or military or judiciary of your country of residence or a foreign government or a senior officer of a foreign Political Party, or a senior executive of an enterprise owned by your country of residence or a foreign government?

Are you a Politically Exposed Person? 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*:

Specify:

Source of Funds*:

Specify:

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

Source of Wealth (only if initial deposit exceeds USD $100,000.00):

Specify:

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:

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

Personal Information

Type of Identification 1

Type of Identification 2

Address Information

Mailing Address

Contact Information

Employment Information

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?

Security Questions*

Terms & Conditions

Please enter the code as displayed*