KYC Individual - Augé Real Estate
Form status
(Required)
First contact
KYC Update
CLIENT IDENTIFICATION
First name / Last name
(Required)
First
Last
Address
(Required)
Street Address
City
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Country of tax residence
(Required)
Last country of tax residence
(Required)
Nationality
(Required)
Passport / ID number
(Required)
Expiration date
(Required)
MM slash DD slash YYYY
Residence card number
Expiration date
MM slash DD slash YYYY
Place of birth
Date of birth
MM slash DD slash YYYY
Phone number(s) (include country code)
(Required)
Email
(Required)
Professional activity
(Required)
Marital status
(Required)
Single
Married
Widowed
Divorced
Separated
Marital regime
(Required)
Community of property
Separation of property
Ultimate beneficial owner of this transaction / business relationship
(Required)
The same person as the customer
Person other than the customer
Specify a person other than the client
(Required)
Ownership stake
Buyer
Seller
Tenant
Lessor
DETAILS OF THE REPRESENTATIVE / ATTORNEY HANDLING THE TRANSACTION
First name / Last name
First
Last
Representative's marital status
Single
Married
Widowed
Divorced
Separated
Marital regime
Community of property
Separation of property
Place of birth
Date of birth
MM slash DD slash YYYY
Passport / ID number
Expiration date
MM slash DD slash YYYY
Residence card number
Expiration date
MM slash DD slash YYYY
Nationality
Address
Street Address
City
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Phone number(s) (include country code)
Email
Position
Administrator
Attorney-in-fact
Others
Specify position
REASON FOR THE INQUIRY
Explain the reason for the consultation
(Required)
PURPOSE OF THE TRANSACTION
Specify the purpose of the transaction
(Required)
Purchase and sale of one or more properties.
Rental of one or more properties.
Real estate brokerage.
Property development.
Property management.
Property investments.
Exchanges.
Others
Other purpose of the transaction
(Required)
PROFESSIONAL ACTIVITY
Specify professional activity
(Required)
Self-employed
Unemployed
Employed
Does not work and receives public/private income.
Retired and receiving a pension.
Entrepreneur
Others
Other professional activity
(Required)
Profession or main activity of the client
(Required)
Job tittle
(Required)
Name of the company
(Required)
Have you ever been involved in any tax audit or inspection procedure?
(Required)
Yes
No
SOURCE OF FUNDS
What is the source of the funds used to carry out the transaction?
(Required)
Yes
Company activity.
Sale of a business or company or one or more properties.
Inheritance.
Bank financing.
Donation.
Investments.
Capital increase
Others
Not applicable, does not involve movement of assets.
Specify the source of the funds
(Required)
Briefly detail the source of the funds used to carry out the transaction.
(Required)
Have the funds that make up your assets or professional activity been acquired in a fully lawful manner?
(Required)
Yes
No
STATEMENTS UNDER ANTI-MONEY LAUNDERING REGULATIONS
Do you use cash frequently in your professional activity?
(Required)
Yes
No
Are you a politically exposed person or do you have any connection with a politically exposed person?
(Required)
Yes
No
Specify if you are a politically exposed person or have any connection with a politically exposed person.
(Required)
METHOD OF CONTACT
Select method of contact
(Required)
Social media.
Website.
Recommendation
Others
Specify method of contact
(Required)
PLACE, DATE, AND SIGNATURE
I declare that this form has been completed by me or in my presence and that the information provided herein is accurate and true. Therefore, I accept that any omission or misrepresentation in the information contained in this form will result in the cancellation of this application and/or the brokerage agreement. Similarly, I undertake to keep the information up to date and to inform AUGÉ REAL ESTATE COMERCIAL of any changes that may arise in the future regarding this information. I authorise the verification of all the information contained in this form at the discretion of the institution. I declare that the income and assets have been acquired through lawful and legitimate activities, and that I have never been involved in any crime of money or securities laundering or other activities 4 considered or that could be considered criminal or that contravene national and international regulations on criminal activities of any kind. Finally, I attest that I have been advised of the scope of Law 17/2014 on the prevention and combating of money or securities laundering and terrorist financing. I hereby inform you, in accordance with the provisions of Law 29/2021 of 28 October, on personal data protection, that your personal data will be included in the personal data files held by this Notary's Office, where it will be kept confidential, without prejudice to any mandatory disclosures.
Date
(Required)
MM slash DD slash YYYY
Signature
(Required)
Δ
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