Identity Verification Form
(Alternative Verification Method)
Client Identity Verification Form
Berardi & Soros Ltd | FORM 93FT
Date: //____
Introduction
This Identity Verification Form is designed to provide you with a secure and efficient
alternative method for verifying your identity directly with our trading platform. We want
to assure you that this verification process is conducted internally by our dedicated
team, ensuring that your information remains confidential and protected. By completing
this form, you acknowledge that we will handle the verification without involving any
external technical partners, allowing for a streamlined and personalized experience.
SECTION 1: Personal/Company Information
1. Full Name (Individual or Legal Representative):
2. Company Name (if applicable):
3. Date of Birth (if individual):
4. Nationality:
5. Tax Identification Number (TIN):
SECTION 2: Contact Details
1. Residential Address or Company Headquarters Address:
o Street: _____________________________________________________
o City: _______________________________________________________
o Postal Code: _______________________________________________
o Country: ____________________________________________________
2. Proof of Address (Attach document, e.g., utility bill or bank statement issued in
the past 3 months):
o Proof for individual clients must match their residential address.
o Proof for legal entities must match the registered company address.
3. Email Address:
4. Phone Number (including country code):
SECTION 3: Verification Questionnaire
(Please answer the following questions truthfully and accurately.)
1. Are you acting in your own name or on behalf of another entity/person?
o In my own name
o On behalf of another entity/person
▪ If acting on behalf of another entity/person, specify details:
2. Declared source of income or funds used for transactions:
o Salary/employment
o Investments/profits
o Inheritance
o Other (please detail): ___________________________________________
3. Do your funds originate from profits generated via our platform?
o Yes
o No
4. Are you or your company currently under any regulatory investigation or
subject to legal proceedings?
o Yes
o No
▪ If yes, please specify:
____________________________________________
5. What is your primary occupation or business activity?
6. Have you previously used any trading platforms?
o Yes
o No
7. Do you have any prior experience in trading or investing?
o Yes
o No
8. What is your investment objective?
o Capital preservation
o Income generation
o Growth/Capital appreciation
o Speculation
9. Have you ever been denied an account by any financial institution?
o Yes
o No
10. Do you have any affiliations with politically exposed persons (PEPs)?
o Yes (please specify): ____________________________________________
o No
11. Is there any additional information you would like to provide that may assist
in the verification process?
SECTION 4: Client Declaration
I, the undersigned, certify that the information provided in this form is true and accurate
to the best of my knowledge. I understand that providing false or misleading information
may result in the suspension or termination of my account and/or legal consequences.
By signing this declaration, I also acknowledge that this verification process is conducted
internally by our dedicated team, ensuring that all information is handled with the
utmost care and confidentiality. This approach allows us to offer a personalized service
without reliance on external technical partners.
Full Name (Printed): ____________________________________________
Signature: _______________________________
Date: //____
SECTION 5: Required Documents
Clients are required to attach the following documents to facilitate the verification
process:
1. A copy of their government-issued photo ID (passport, national ID, or driving
license).
2. Proof of address (recent utility bill or bank statement).
3. For legal entities:
o Company registration certificate.
o Proof of business address (e.g., utility bill, tax document).