Client-Information-Sheet-客户信息表—曾总资料.doc

昆山淀山湖庄园房地产发展有限公司

Client Information Sheet 客户信息表
In accordance with Articles two (2) through five (5) of the Due Diligence Convention and the Federal Marketing Commission Circular of December 1998, concerning the prevention of money laundering, the following information may be supplied to banks and/or other Federal Institutions for verification purposes.
按照反洗钱法，下列提供给银行和/或联邦机构的信息用于查询用。
1) Borrower’s Name
借方名称：
Full Name of Business
公司名称：
Business Address
营业地址：
Business Registration No.
营业执照号码：
Registered Address
注册地址：
Telephone
电话号码：
Facsimile
传真号码：
E-Mail Address
电子邮件号码：

2）Signatory’s Information
签字人资料
Full Name
姓名：
Nationality
国籍：
Passport No.
护照号码：
Passport-Issuing Country
护照签发国：
Date if Issue
护照签发日期：
Place of Issue
护照签发地：
Date of Expiration
护照到期日：
Date of Birth
出生年月日：
Place of Birth
出生地：
SSN/National Identity No.
身份证号码：
Home Address
家庭住址：
Home Telephone
家庭电话：
Mobile Telephone
移动电话号码：
Facsimile
家庭传真号码:
E-Mail Address (personal)
个人电子邮件：

3）Legal Representative
法律顾问
Counsel Full Name
法律顾问姓名:
Law Firm Name
律师事务所名称：
Address
律师事务所地址：
Telephone
律师事务所电话：
Facsimile
律师事务所传真：
E-mail Address
律师事务所电子邮件：

4）Borrower’s Paying Bank
借方付款银行
Name of Bank
银行名称：
Bank Address
银行地址：
Account Name
账户名称：
Account/Signatory
账户签字人：
Account No.
账号：
Bank Officer
银行官员：
Telephone
银行电话：
Facsimile
银行传真：
E-mail Address
银行电子邮件：
S.W.I.F.T. Code
银行SWIFT代码：
ABA Code
汇款ABA代码

5）Borrower’s Receiving Bank
借方接证银行
Name of Bank
银行名称：
Bank Address
银行地址：
Account Name
账户名称：
Account/Signatory
账户签字人：
Account No.
账号：
Bank Officer
银行官员：
Telephone
银行电话：
Facsimile
银行传真：
E-mail Address
银行电子邮件：
S.W.I.F.T. Code
银行SWIFT代码：
ABA Code
汇款ABA代码

6）Funds of Information
资金信息
Origin
资金来源：
Are Funds clean and clear?
资金是干净、清洁的吗？

7）Bank Readiness
银行准备
My Bank is aware of this YES知道/NO不知道. [also
transaction enter the name of the bank
也要在此写上银行名称]
我的银行知道此交易

Name of Bank Officer
银行官员：
Contact info [email address and telephone
联系信息： number 银行官员电子邮件和电话号码]

7）Brief Description of Corporate Activities
公司业务活动简述：

Declaration 声明：I hereby swear under penalty of perjury, that the information provided is both true and accurate. I am the signatory on the aforementioned bank account. All monies engaged in this transaction are derived from non-criminal origin; and, are good, clean and cleared. The origin of funds is in compliance with Anti-Money-Laundering Policies as set forth by the Financial Action Task Force (FATF) 6/01.
我在此宣誓，若作假愿受罚，我所提供信息是真实、准确的。我是前述银行账户的签字人。用在本交易的款全部是非犯罪来源的，是良好、清洁、干净的。资金的来源符合金融法规（FATF）6/01反洗钱法的规定。

Signed at on this Day of
年 月 日在 签字

Corporate Seal
公司盖章
5