Eduardo B. Aguilar & Associates

New Business Name — Client Information Form

The services we provide are under a licensed industry regulated by the Financial Intelligence Unit of Belize, mandated to comply with Know Your Customer (KYC) legal requirements. Your kind cooperation in completing the following is greatly appreciated. Fields marked * are required.

Personal Information

First Name *

Middle Name

Surname *

Maiden Name

Nickname / Also Known As

Nationality *

Current Address

Apt / House Number

Street

City

State / Province

Country

Zip / Postal Code

Contact Details

Mobile Number *

Email Address *

Secondary Contact

If you are unable to be reached on your mobile and/or email, who can we contact?

Contact Person

Number

Email Address

Registration of Business Name

Name of Business (I) *

Main Objective (II) *

Address of Business (III)

Apt / House Number

Street

City

District

Accounting Records Address (IV)

Physical address where accounting records will be kept, if different from the business address above.

Apt / House Number

Street

City

District

Person Responsible for Accounting Records (V)

Name

Contact Number

Email Address

Owner Information

Owner 1

Name of Owner *

Address

Owner 2 (if applicable)

Name of Owner

Address

Supporting Documents

The following documents are required from yourself and from anyone else being a party to this transaction:

Valid ID — A clear, color copy of a government-issued ID with photo identification and signature (e.g. Passport or Driver's License). Nothing is to be displayed in the background of the copy provided.
Proof of Address — A recent utility statement clearly displaying your name and address as stated in this form.

Please send supporting documents to [email protected] referencing your business name.

Indemnification

I/We hereby declare:

That I and all the parties to this transaction are not involved, to the best of my knowledge, in any illegal or illicit activities. I assure Eduardo B. Aguilar & Associates that the funds provided are all from a legitimate source and confirm that the services I am requesting are all for legitimate purposes.
That I/we declare and confirm that I/we WILL NOT USE the said Business for money laundering, terrorist activities, or any other illegal activities, or in a manner likely to damage the good name of Eduardo B. Aguilar & Associates or the jurisdiction of registration.
That the information provided herein is not intended to defraud, harm, or cause any party to this transaction to become unknowingly involved or participatory in any form of illegal or corrupt conduct. I agree to hold harmless and indemnify Eduardo B. Aguilar & Associates and all its affiliates, representatives, and industry partners against any claims, losses, liabilities, or settlements arising out of any reliance upon any statement or information which may hereafter prove to be untrue, materially inaccurate, or that was knowingly withheld.

I have read and understand the above and agree to provide any further information that may be needed. I am in agreement with engaging the services of Eduardo B. Aguilar & Associates.

Signature of Owner (1)

Draw your signature above

Signature of Owner (2)

Draw your signature above

Date

Dated this

day of

Your submission will be sent securely to Eduardo B. Aguilar & Associates.

Prefer to complete the form manually?

Download the PDF version of this intake form, complete it by hand or digitally, and email the signed copy directly to our office.

PDF Form

Business Name Intake Form — July 2026

Eduardo B. Aguilar & Associates

Download PDF

Once completed, email your signed form to [email protected]