_Client Identification Form

  
Please complete this form in order to get your file opened.
 
 
 
Company*
 
 
Legal Form
 
 
RCS Number*
 
 
NACE Code
 
 

>> List of NACE codes

 
Do you have a VAT Number?*
 
Yes
No
 
VAT Number
 
 
 
 
 
Address: 
 
 
Number and Street
 
 
City
 
 
Postal Code
 
 
Country*
 
 
 
 
 
Contact Person: 
 
 
Civility*
 
 
First Name*
 
 
Last Name*
 
 
Job Title
 
 
 
 
Email Address*
 
 
Phone number
 
 
 
 
 
 
Ultimate Beneficial Owners and Senior Managing Officials 

Please download the UBO-SMO form, fill it in and upload it below:
  
Upload UBO-SMO Form*
 
 
 
Upload Organisation Chart of your Company
 
 
 
 
 
 
 

Billing Information:

  
 
Is the entity or address to invoice different from the above?*
 
 
Please fill in this section only if billing information is different from the above.
  
Company
 
 
Legal Form
 
 
Full Address
 
 
RCS Number
 
 
VAT Number
 
 
NACE Code
 
 
Contact Person
 
 
 
Email Address
 
 
 
 
 
 

By returning us this form, the ultimate beneficial owner(s) / SMO(s) hereby acknowledge and accept that Wildgen, in order to fully comply with its professional obligations, collects your personal data as per this document and store them for a maximum duration of ten years and in any case solely as necessary to comply with the said professional obligations.To enable us to amend and delete any inaccurate data, kindly inform us of any change in the data collected by email at the following address: privacy@wildgen.lu. This address shall be used for any communication or request regarding the use of your personal data by Wildgen S.A. To go further, kindly refer to the information provided on our website www.wildgen.lu/privacy-statement.