International Client Application Form

About this Application

This is an International Client Application Form. Please read it carefully, as you select products and services, please advise the best way to communicate with us, and agree to certain provisions that will govern our relationship. Once accepted, this application and all accompanying or supplemental documents form the entire agreement between us for this account. Unless otherwise indicated in this application, the words “you,” “your,” “yourself,” and “yours” mean the applicant(s). The words “we,” “us,” and “our” mean Genesis Capital Group Limited in Genesis Capital Group Limited and our branches, subsidiaries, and affiliates.

Getting Started

Please complete and sign this application and submit along with any required supplemental forms identified through this application process.

In order to complete this application, you will need the following information:

  • Identification information, such as a driver’s licence, passport, or another type of government-issued identification
  • Social Security Number
  • Information about your annual income, debt, expenses, and net worth
  • Fields marked with red * are required.

The above information helps us comply with various securities regulations and rules and the USA Patriot Act information (Required by Federal Law), a Federal law that requires all securities firms to obtain, verify, and record information that identifies each applicant. The information also helps us more fully understand your investment profile and identify what types of investments or strategies may be suitable for you. Please note: if we cannot verify the information you provide, we may be required to restrict or deny your account.

Please remember to notify us if you experience a significant life change, such as the birth of a child, marriage, divorce, death of a spouse, loss of a job, change in financial situation, etc.

Application Disclaimer
Applicant(s) Details
Primary Account Holder
Secondary Account Holder (for joint accounts only)
Professional Information
Employment Status

USA Patriot Act Information (Required by Federal Law)

All applicants please provide the information below. Non-resident aliens.

Please provide the Country of Tax Residence if different from Country of Citizenship

Asset Declaration
Industry and Other Affiliations

Are you, your spouse, or any other immediate family members, including parents, in-laws, siblings and dependents:

  • Employed by or associated with the securities industry (for example, a sole proprietor, partner, officer, director, branch manager, registered representative or other associated person of a broker-dealer firm) or a financial services regulator?

    Primary Applicant
    Co-Applicant

    If yes, please specify entity below. If this entity requires its approval for you to open this account, please provide a copy of the required authorization letter (with this Application).

    (**Including a national securities exchange, registered securities association, registered clearing agency or the Municipal Securities Rulemaking Board.)

  • An officer, director or 10% (or more) shareholder in a publicly-owned company?

    Primary Applicant
    Co-Applicant

    If yes, please specify the name of the company and symbol.

  • A senior military, governmental or political official in a non-US country?

    Primary Applicant
    Co-Applicant

    If yes, please specify the country.

    (Firms may consider whether to include this question in the context of their risk assessment procedures and the products and services they offer.)

Financial Situation and Needs, Liquidity Considerations, and Tax Status

Please tell us your best estimate as to:
Timeframe for special expenses: *

Liquidity Needs *

The ability to quickly and easily convert to cash all or a portaion of the investments in this account without experiencing significant loss in value from, for example, the lack of a ready market, or incurring significant costs or penalties is.

Annual Income includes income from sources such as employment, alimony, social security, investment income. etc.

Net Worth is the value of your assets minus your liabilities. For purposes of this application, assets include stocks, bonds, mutual funds, other securities, bank accounts, and other personal property. Do not include your primary residence among your assets. For liabilities, include any outstanding loans, credit card balances, taxes, etc. Do not include your mortgage.

Liquid Net Worth is your net worth minus assets that cannot be converted quickly and easily into cash, such as real estate, business equity, personal property and automobiles, expected inheritances, assets earmarked for other purposes, and investments or accounts subject to substantial penalties if they were sold or if assets were withdrawn from them.

Annual Expenses might include mortgage payments, rent, long-term debts, utilities, alimony or child support payments, etc.

Special Expenses might include a home purchase, remodeling a home, a car purchase, education, medical expenses, etc.

Decision-Making (check all that apply)

Financial Investment Experience

Please provide the following information below in order for us to fully understand your investment experience. We are aware that the information you provide may change over time as you work with us. Please check the boxes below to best describe your investment experience to date.

Investment Years of Experience Transactions Per Year
(excluding automatic investments)
Mutual Funds/ Exchange Traded Funds
Individual Stocks
Bonds
Options
Securities Futures
Annuities
Alternative
Margin (May include structured products, hedge funds, etc.)
Investment Objectives

Please answer the following questions regarding your investment targets and investment period of time in order for us to determine which investment products and strategies are suitable for you.

The expected period of time you plan to invest to achieve your financial goal(s): *

Investment Risk Tolerance *

Different investment products and strategies will involve different levels of risk. When choosing different products and strategies you must understand that higher expected returns will involve different degrees of risk and therefore it may cause you to lose the majority of your investment. Investments should be chosen based on your objectives, timeframe, and tolerance for market fluctuations.

KYC & AML Document Submission
KYC (Know Your Client):

KYC is a standard information gathering exercise in the investment industry that ensures investment professionals know detailed information about their clients’ risk tolerance, investment knowledge and financial position. The KYC process protects both the client and investment professional. Clients are protected by having their investment manager know what investments best suit their personal situations. Investment managers are protected by knowing what they can and cannot include in their client’s portfolio. The KYC rule is an ethical requirement for investment professionals who are dealing with customers during the opening and maintaining of accounts.

AML (Anti Money Laundering):

AML refers to a set of procedures, laws and regulations designed to stop the practice of generating income through illegal actions. Though anti-money-laundering laws cover a relatively limited number of transactions and criminal behaviours, their implications are far-reaching. For example, AML regulations require financial institutions to complete due-diligence procedures (such as requiring client identification documents) to ensure they are not aiding in money-laundering activities.

MLRO (Money Laundering Reporting Officer):

A firm’s designated MLRO is responsible for ensuring that information leading to knowledge or suspicion of money laundering is properly disclosed to the relevant authority. The MLRO will also liaise with law enforcement on the issue of whether to proceed with a transaction or what information may be disclosed to clients or third parties.

Passport / National ID / Driving License.
Please upload an identification document in color in PNG, JPEG, JPG or PDF format displaying your full name.
The image must be high quality, unobstructed and show the full document page.
In cases of national ID document, both sides of the ID card must be uploaded.
The document must have more than 3 months validity.

Please upload a proof of address in PNG, JPEG, JPG or PDF format.
Proof of address must be no more than 180 days old (utility bill / bank statement / other financial document).
The document must be issued in the applicant’s name and show their current residential address as provided during the registration.
The image must be high quality, unobstructed and show the full document page.

Confirmation and Signatures

Important Information: Please note that the value of investments, and any income derived from them, can decrease as well as increase so you could get back less than you invest. If you are unsure of the suitability of any investment, please seek advice from your tax or legal adviser. Tax regulations can and do change, and the value of any benefits depends on your circumstances.