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Application form: Trades & Sales Registration

General information
First name
Surname
Country
Postal code + building number
Street
Location / City
E-mail
Phone number
Questions
Name of Agent Representative
PP/DL/ID #
Identification Type
Issuing Country
Date of Issue
Date of Expiry
What's your role?
What service type are you applying for?
Do you require payment exchange services?
Will you be opening a currency account?
If Yes, what type of currency account is being opened?
Will your currency transactions be higher than one million?
Can you provide proof of funds for this service?
What swift message types can your bank issue? (Select all that apply)
MT110
MT199
MT542
MT700
MT760
MT799
Euroclear
DTC
Other (Please explain)
What type of bank instrument do you require?
Other (Please explain)
Are you the owner of the following bank instruments? (Select all that apply)
SBLC
Bank Draft
CD
Other (Please explain)
Please select the bank instrument that are leased or soon to be issued?
Other (Please explain)
If individual buyer, can client provide a POF or Bank Tear Sheet?
Is the client an individual or institutional buyer?
If institutional buyer, can client provide institutional number?
Date of Incorporation
Registration Number
Company Name
Address
City
State
Zip Code
Country
Telephone/Fax
Company Email Address
Does the client speak English
If no, preferred language
Translator Name
Translator Number
Translator Email Address
Legal Adviser Name
Company Name
Address
City
State
Zip Code
Country
Telephone/Fax
Email Address
Name on Bank Account
Bank Name
Address
City
State
Zip Code
Country
Account / IBAN #
Swift Code
Routing / ABA #
Account Type
Bank Officer Name
Telephone/Fax
Email Address
Cover letter
I hereby agree to the Privacy Statement and that my personal data will be processed. This information will be treated confidentially by us and will only be used for recruitment and selection purposes.

Contact information

Name Financial International Connections Association, LLC
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