Beluga Aequitas Association — Application Form

Basic Information

Member ID #:

DOB (yyyy-mm-dd):

Passport #:

Passport Exp (yyyy-mm-dd):

Driver Lic. #:

Driver Lic. Exp (yyyy-mm-dd):

Legal Last Name:

First Name:

MI:

Nickname:

Social Media Name:

Home Address

Address:

City:

Province/State:

Zip Code:

Country:

Mailing Address Same as Home

Contact Information

Telephone (Cell):

Telephone (Home):

Telephone (Work):

Email (Personal):

Email (Business):

URL (Charitable Website):

Preferred Contact Method:

SMS

Email

Time Zone:

Language Preference:

Interface with Bitrix24:

Mac

Windows

iPhone

Android

Special Needs:

Pets:

Anniversaries:

Project Involvement

Projects:

Countries of Project(s):

Project Involvement:

Investor Type

Solo Projects

Group Projects

Payment Method:

Bitrix24:

POLITICAL EXPOSED PERSON (PEP) OR GOVERNMENT EMPLOYMENT

Are you a Political Exposed Person (PEP)?

Are you employed by a Government?

If it applies, please confirm status:
Active Dismissed Retired Other

ACADEMIC QUALIFICATION (OPTIONAL)

Are you holding an Academic Qualification?

If YES, please specify:

PROFESSIONAL ACTIVITY / OCCUPATION (OPTIONAL)

Retired Employed Self-Employed Other

Occupation:

Company:

Nature of Business:

Emergency / Referral

Emergency Contact Person:

Phone:

Email:

Address:

City:

Province/State:

Zip Code:

Country:

COPY OF IDENTIFICATION DOCUMENT (COMPULSORY)

ELIGIBLE / ACCEPTABLE: Color copy of valid Passport, Identity Card, Driver’s License.

The Applicant is entitled to disclose only the ID Number of document, while for representation by the Association, Member shall then provide CIS - Client Information Sheet at later stage.

Identification Document No.:

Copy of Document:

Confirm Information

All your information is current and correct

Date (yyyy-mm-dd):

E-Signature:

Referral Person: