AML KYC Signatory Identification Form & Agent Instruction Adult July 2009 V_032017
{Insert Date} {Insert Agent's Name} {Insert Agent's Address} {Insert Agent s Firm} {Insert Agent's Phone Number} Dear : Re: Ascertaining the Identity of an Account Signatory In order to comply with the Proceeds of Crime (Money Laundering) and Terrorist Financing Regulations in Canada, CST Trust Company ( CST ) is required to ascertain the identity of signatories authorized to act with respect to an account. We hereby appoint you to act on CST s behalf with respect to ascertaining the identity of {Insert Name(s) of Signatory}. Accordingly, please confirm their identity in accordance with the following instructions. It is your responsibility to ensure that each of the following steps is fully and accurately completed: 1. Obtain from the signatory the information outlined on the Signatory Identification Form (SIF) enclosed herewith. Please meet with the signatory when completing the SIF as the Regulations require the agent to meet with the signatory in person. If there is more than one signatory, please complete a separate SIF for each signatory. 2. Each signatory must present to you at least one valid (i.e. unexpired) piece of State or Federal government issued photo identification (the Acceptable ID ). The Acceptable ID must: indicate the client s name. have a photo of the client have a unique identifier number 3. Please record on the SIF, where indicated, the following: the full name of the Signatory; the date of birth of the Signatory; the type of Acceptable ID presented; the expiry date of the Acceptable ID viewed, if available; Acceptable ID reference or registration number place of issue.
4. Please ask the Signatory to sign the SIF where indicated, and please provide your confirmation (i.e. your seal or registration/license number) that you witnessed such signature by checking-off Yes where indicated on the SIF, otherwise check-off No and provide a brief explanation where indicated. 5. Please provide your confirmation that the person presenting himself/herself to you as the Signatory appears to be the person in the photograph by checking-off Yes where indicated on the SIF, otherwise check-off No and provide a brief explanation where indicated. 6. Notwithstanding the completion of instructions 1. to 5. above, if you have any reason to believe that the person presenting himself/herself to you as the Signatory is not such individual, then please check-off Identity Not Ascertained and provide a brief explanation where indicated on the SIF, otherwise check-off Identity Ascertained where indicated. 7. Please sign and date the SIF form(s) and the Agent Agreement and forward originals to CST, at the following address: CST Trust Company Dividend Reinvestment P. O. Box 4229, Station A Toronto, Ontario M5W 0G1 Please also retain one copy of each SIF for your files. The attached form is only to be used to ascertain the identify of an account holder who is over 18 and has Acceptable ID : We thank you in advance for your prompt service in respect of this matter, and should you have any questions regarding this letter or the SIF, please contact the undersigned directly. Kind Regards, CST Trust Company 320 Bay Street, 3 rd Floor Toronto, ON M5H 4A6
AML KYC Signatory Identification Form (Agent) ADULT (Account holder 18 and over with Acceptable ID To: CST Trust Company From: Agent name and address to appear above. Pursuant to the agent agreement and instructions I am acting on behalf of CST with respect to ascertaining the identify of the Account Signatory named below. 1. Client s Legal Name: 2. Account Signatory Full Name: Date of Birth: Address: 3. Acceptable ID: Note: One unexpired original piece of State or Federal government issued ID bearing the photograph must be presented. Type of ID: Expiry Date (if applicable): ID Reference/Registration Number: Place of Issue (jurisdiction and country): 4. Signature of Account Signatory: To be signed in the presence of the Agent 5. I, the Agent, confirm by indicating YES below, that I witnessed the above signature of the Account Signatory, otherwise where I have indicated NO a brief explanation is provided. YES NO 6. I, the Agent, confirm by indicating YES below, that the person presenting himself/herself to me as the Account Signatory appears to be the person in the photograph included in the Acceptable ID described in Section 3 above. Otherwise, I have indicated NO and provide a brief explanation belowp. YES NO
Explanation of why I indicated NO : 7. I, the Agent, confirm by indicating Identity Ascertained below, that I do not have any reason to believe that the person presenting himself/herself to me as the Account Signatory is not the individual, or the acceptable ID presented was not genuine otherwise I have indicated Identity Not Ascertained and provided a brief explanation below. Identity Ascertained: Identity Not Ascertained: Explanation of why identity not ascertained: Agent Acknowledgement & Signature The Agent acknowledges its appointment as Agent of CST and hereby accepts and agrees to the terms and conditions set out in this letter: Name of Agent: Occupation: Dated at this day of, 20. Signature of Authorized Agent