Individual Account - Index & Cie

Individual Account Opening

Personal Information

Client Profile

Financial Information

Review

Personal details

Title*

Mr.

Ms.

First name*

Family name*

Marital Status*

Date of Birth*

Nationality*

Legal Address

Street Address*

Post Code*

City*

Country*

Contact Details

Mobile Phone Number*

Phone Number*

Email Address*

I would like to receive my bank account password by*

SMS

Employment Status

Select the appropriate*

Employed

Self Employed

Unemployed

Retired

Student

Other

Employed

What is the name and address of your employer?*

Business Sector*

What is your current job?*

What is the website address of your employer?

Self-employed

What is the name and address of your company?*

What is the business sector of this company?*

What is your current job?*

What is the website address of the company?

What is/was the level of participating interests (share %) that you hold / held in the company?

Unemployed

Last occupation*

Last employer*

Retired

What was your status in your previous activity?*

Employed

Self Employed

Other

Retired-Employed

What is/was the name and address of your previous employer?*

What is/was the business sector of this company?*

What was your job?*

What is / was the website address of your previous employer?

Retired-SelfEmployed

Is the company in question still active?*

Yes

What is / was the name of this company?*

What is / was the business sector of this company?*

What was your job?*

What is / was the website address of your previous employer?

What is / was the level of participating interests (share %) that you hold / held in the company?*

Retired-Other

Please specify*

Student

Field/faculty*

School/University*

Other

Please specify.*

Please specify Other*

Leadship Position

You confirm that you do not hold a leadership position within a company that has issued listed securities or within a group comprising a company whose shares are listed*

Yes

Executive position*

secondary activity

I also have a secondary activity*

Yes

What is your status with regard to this activity?*

Employed

Self Employed

Other

secondary activity-Employed

What is the name and address of your employer?*

What is your current job?*

What is the website address of your employer?

secondary activity-Self-employed

What is the name and address of your company?*

What is your current job?*

What is/was the level of participating interests (share %) that you hold / held in the company?*

What is the website address of the company?

secondary activity-Other

Please specify*

Important public function

Do you exercise any important public function?*

Yes

Public function description*

Tax residence

Residence(s) for tax purposes (self-certification for the Automatic Exchange of Information)

On 21 July 2014, the Organisation for Economic Co-operation and Development (OECD) released a Standard for Automatic Exchange of Financial Account Information in Tax Matters. The Client understands that the Bank may need to apply enhanced due diligence procedures to record the residence for tax purposes of the Client. In the above-mentioned context and, in particular, as part of the account opening process, the Client provides the Bank with the following information:

Residence*

Tax ID (if available in your country)

Nature of Tax ID

Please specify Nature of Tax ID

Section Title

For further information on the residence for tax purposes, reference is made to the General Terms and Conditions. You may need to refer to a tax advisor and/or to sources publicly available in order to duly complete this section.

Declaration of “non-US person” or “US person” status

The Bank has entered into a so-called “Qualified Intermediary” (“QI”) Agreement and a “Foreign Financial Institution” (“FFI”) Agreement pursuant to the Agreement between Switzerland and the United States of America (“USA”) for cooperation to facilitate the implementation of the “Foreign Account Tax Compliance Act” ("FATCA", together with the FFI Agreement, the “FATCA Regulations”) with the US tax authorities ("IRS"). In the above-mentioned context, the Client confirms that:*

he is a “non-US person”, i.e. he is not a US citizen (be it by single, dual or multiple nationalities) and does not have a “resident alien” status (for example he is not holding a “Green Card” and has not been a long-term resident in the USA in the current year and the previous two years). Further, the Client confirms that he is the beneficial owner of the securities held and the income generated therewith in accordance with US tax law. In the event of an existing double taxation treaty between the USA and the Client’s country of residence, the Client asks for and the Bank grants to the Client, in principle, a reduction of the US withholding tax on income of US origin. In such a case, and depending on the circumstances, the Bank is entitled to ask for additional documentation. The Bank is also entitled to ask for further documentation if U.S. indicia are identified;

he is a “US person”, i.e. he is a US citizen (be it by single, dual or multiple nationalities) or he has a “resident alien” status (for example because he is holding a “Green Card” or has been a long-term resident in the USA in the current year and the previous two years). Further, the Client confirms that he is the beneficial owner of the securities held and the income generated therewith in accordance with US tax law. If the Client is or becomes a US person, the FATCA Regulations require that the Client provides the Bank with a Form W-9. By providing a Form W-9 to the Bank, the Client accepts that the Bank shall provide, directly or indirectly, the IRS, the Bank’s withholding agents and custodians, or any related parties, with confidential and personal information about the Client and his Accounts with the Bank, such as the Client’s identity, name and address, his Tax Identification Number (“TIN”), the Account number, the Account value and income and gains as well as documents such as IRS forms. The Client hereby irrevocably consents to such disclosure and fully releases the Bank from their obligations of banking secrecy, confidentiality and/or data protection under Swiss or any other applicable law(s) which might otherwise preclude the disclosure of such information (“Banking Secrecy Waiver”).

Furthermore, the provisions of the General Terms and Conditions apply.

Account information

Planned Investment*

What do you estimate your global assets to be (real estates included)?*

Wealth

What is the breakdown of your wealth?

Cash assets

Securities (equities, bonds, investment fund units, etc.)

What approximate share of your wealth consists of liquid assets?*

What approximate share of your wealth consists of transferable securities?*

Real estates

Industrial assets (e.g. company)

Other(s)

What approximate share of your wealth consists of real estates?*

What approximate share of your wealth consists of industrial assets?*

Please specify other(s)*

What is the source of the money in the account to be opened?*

Savings

Income

Inheritance

Sale of real estate

Pension (AI, AVS - Swiss disability and retirement pensions respectively)

Trading gains

Gift

Lottery winnings / Miscellaneous gains

Capital from an occupational pension planning

Divorced

Other(s)

Please specify other source*

various possible sources

Which, of the various possible sources, is the main source of the money in your account?*

Use

Use of Account*

Receipt of commission

Payments

Fiduciary deposit(s)

Formation of capital

Payment of commission

Trading

Savings

Credit Card

Other(s)

Please specify other Use of Account

Beneficial Owner

Identification of the Beneficial Owner (Form A pursuant to the Agreement on the Swiss banks’ code of conduct with regard to the exercise of due diligence, CDB).*

The account holder is the beneficial owner of the assets deposited with

The account holder declares that the beneficial owner of the assets deposited with

(Please fill out the form below)

Title*

Mr.

Ms.

First name*

Family name*

Date of Birth*

Nationality*

Street Address*

Post Code*

City*

Country*

Reference account

Please note that all cash inflows and outflows will be made from and to your reference account(s), which must be under your own name You can add several reference accounts, as long as they are under your own name. Cash outflows cannot be transferred to a third party, likewise cash inflows cannot be accepted from a third party's account.

Type*

BIC (Swift)

ABA Routing

BIC (Swift)*

IBAN*

Bank name*

Bank City*

Bank Country*

Section Title

Declaration*

I declare that all information is accurate and up to date*