MCP

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Client Information Form

Identity:

Name
Martina Borbleyova
Phone number
0639857894
Birth place
Date of birth
29/04/1992
Professional situation :
Sector of activity
Professional situation
Place of work
Personal Situation :
Marital statuts
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Single
Other
Information regarding spouse :
Family name
Firstname
Date of birth
Place of birth
Profession
Socio-economic background :
Information on the origin of the assets
How did you build your weath?
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Professional income (salaries)
Could you tell us more about how you builtup your assets?

Monaco Properties, 14 boulevard d'Italie, 98000 Monaco

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Origin of funds
Bank information
Bank Name
Bank Address
Bank Account Name
Private Banker Name
Additional comments regarding banking information
These specific funds originate from…
Professional income (salaries,bonuses, dividends…)
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NO
Inheritance / Gift / Succession
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NO
If Yes (specify date & relationship to donor or deceased)
Savings
If Yes (specify date & relationship to donor or deceased)
If Yes (specify date & nature / sector of activity)
If Yes (specify date & relationship)
Real Estate Sale
Sale of movable property (works of art, vehicle, jewerly)
Sale of business assets or company shares
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NO
Benefit from a life insurance contract
Benefit or compensation (accident, divorce, death…)
Surrender of a life insurance / capitalization contract
Gambling winnings (casino, lotto, betting…)
Other
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YES
Yes (specify nature, d
ate, home institution)
Other info
Political statuts
Do you hold or have you held important public functions in Monaco or in a foreign country during the last 12 months
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NO
If Yes (specify)
Are you, or have you been closely associated with a person holding or having held important public functions in Monaco or a foreign country during the past 12 months?
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NO
Yes (specify)
Additional comments
Certification
I certify on my honor that the sums which are or will be paid under this contract do not have a criminal origin in the sense of the regulation relating to money laundering.
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YES
I certify on honor that the elements appearing on the present document
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YES
Date:
01/31/2025
Signature
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Monaco Properties, 14 boulevard d'Italie, 98000 Monaco

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Monaco Properties, 14 boulevard d'Italie, 98000 Monaco

About this template
Categories
Details
1 Clone
Created by
Monaco_Properties
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These templates are suggested forms only. If you're using a form as a contract, or to gather personal (or personal health) info, or for some other purpose with legal implications, we recommend that you do your homework to ensure you are complying with applicable laws and that you consult an attorney before relying on any particular form.