Eduardo B. Aguilar & Associates

Client Information Form

The services that we provide are under a licensed industry regulated by the Financial Intelligence Unit of Belize and the Financial Services Commission (FSC) tasked with ensuring businesses comply with Belize's Anti-Money Laundering Regulations. We are therefore mandated by law to comply with the "Know Your Customer" legal requirements. Those requirements include obtaining information from all parties.

Your kind cooperation in completing the following will be greatly appreciated.

★

For Company / Business Name

I am a member of the following Companies and/ or Business Name(s) with Eduardo B. Aguilar & Associates being the Registered Agent.

Company / Business Name

Personal Information

First Name *

Middle Name

Surname *

Maiden Name

Nickname / Also Known As

Nationality *

Do you have Dual Citizenship / Nationality?

YesNo

Current Address

Apt / House Number

Street *

City *

State / Province

Country *

Zip / Postal Code

Is the above address your Mailing Address?

YesNo

Secondary Contact — if you cannot be reached on your mobile and/or email

Contact Person

Number

Email Address

Occupation / Income

(I) My usual source of income over the past two years has come primarily from my: *

(II) State your occupation

Briefly describe what you do

(III) If retired, what did you do prior to retirement?

(IV) If employed or a business owner, please complete below

Name of Company

Type of Business

Position You Hold

Length of Employment / Ownership

Contact Details of the Company / Business

Phone

Location / Address

Politically Exposed Person (PEP)

Are any of the directors, shareholders, members or beneficial owners a Politically Exposed Person (PEP)? A PEP is an individual who is or has been entrusted with a prominent public function — whether in Belize, a foreign country, or by an international organization — and includes their immediate family members and close associates.

Is any party to this matter a PEP? *

YesNo

Indemnification

•

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 Company/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/participatory in any form of illegal or corrupt conduct/function. 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-mentioned and agree to provide any further information that may be needed. I am in agreement with engaging the services of Eduardo B. Aguilar & Associates.

Date

Given thisday of

Client / Beneficial Owner (Print Name) *

Signature *

Your information is transmitted securely and used solely for KYC/AML compliance purposes.

Prefer to complete the form manually?

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

PDF Form

Client Information Form 2026

Eduardo B. Aguilar & Associates

Download PDF

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