Quality Group SA – Referral Form New Business Referral Form Investment Owner(s) SingleJoint Applicant Details arrowup6 1st Signatory (Full Name) * Email * Confirm Email * Mobile No * 2nd Signatory (Full Name if applicable) * Email * Confirm Email * Mobile No * Applicant Details arrowup6 1st Signatory (Full Name) * Email * Confirm Email * Mobile No * Supporting Documentation (Clear Copies Required) arrowup6 Valid Passport * Drop a file here or click to upload Choose File Maximum file size: 10MB Valid Passport - 2nd Signatory * Drop a file here or click to upload Choose File Maximum file size: 10MB Kindly select and upload ONE of the following * Valid Country ID (if ID card both sides) Valid Driver's License (both sides) Valid Country ID (if ID card both sides) Drop a file here or click to upload Choose File Maximum file size: 10MB Valid Country ID (if ID card both sides) - 2nd Signatory Drop a file here or click to upload Choose File Maximum file size: 10MB Valid Driver's License (both sides) Drop a file here or click to upload Choose File Maximum file size: 10MB Valid Driver's License (both sides) - 2nd Signatory Drop a file here or click to upload Choose File Maximum file size: 10MB Account Holder(s) Name(s) as on Bank Statement * Full Name of Bank * Address of Bank * Account Number * Branch / Sort Code * Swift Address (if applicable) IBAN Number (if applicable) Account Currency * Type of Account * Copy of current Bank Statement showing where funds are coming from * Drop a file here or click to upload Choose File Maximum file size: 10MB Proof of Address (not older than 3 months) Dropdown * Utility BillTelephone Account (Not Mobile)Current Rental Agreement, signed by all partiesCo-habitation letterBank Statement (Where one resides) Upload Proof of Residence * Drop a file here or click to upload Choose File Maximum file size: 10MB Proof of Address (not older than 3 months) Dropdown * Utility BillTelephone Account (Not Mobile)Current Rental Agreement, signed by all partiesCo-habitation letterBank Statement (Where one resides) Upload Proof of Residence * Drop a file here or click to upload Choose File Maximum file size: 10MB Source of Wealth arrowup6 Please select how you will be funding this investment (Ctrl+Click for Multiple selection) * EmploymentRetained EarningsSavingsInvestmentsPensionAnnuityProperty SaleOther Please select how you will be funding this investment (Ctrl+Click for Multiple selection) Kindly upload Source of Wealth Document * Drop a file here or click to upload Choose File Maximum file size: 134.22MB Investment Criteria arrowup6 Investment Funding Lump SumRecurring Lump Sum Investment Select currency of Investment * GBPUSDEURZAR GBP Amount (Minimum 5,000 in multiples of 1,000) USD Amount (Minimum 10,000 in multiples of 1,000) EUR Amount (Minimum 10,000 in multiples of 1,000) ZAR Amount (Minimum 100,000 in multiples of 1,000) Would you like Income or Growth? IncomeGrowthIncome & Growth Income % Growth % Recurring Investment Recurring Options USD Life Cover, Severe Illness, Disability - Min $50USD Investment in Funds - Min $200pmEUR Investment in Private Lending - Min €200pmZAR Investment in Community Schemes - Min R1000pm Amount available to invest monthly AML Compliance Questions arrowup6 Have you ever been adjudged by a court, civilly liable for any fraud misfeasance or other misconducts? * No Yes Have you, ever, been associated or been subject of an investigation by a government exchange, professional or other regulatory body or agency? * No Yes Have you ever been criminally charged? * No Yes Are you a Political Exposed Person (PEP)? * No Yes Do you have any additional information, which should be brought to the Provider/s attention, which may have an impact on the evaluation by AML Compliance of your good character and integrity? * No Yes Have you ever been liquidated or sequestrated? * No Yes Other / Notes (To elaborate on any of the compliance questions) Captcha Should the bank account be held in one name, the signatories to this investment agree that all benefits may be credited to the bank account information as stipulated above even though the intended investment is owned by both signatories Signature - Investor 1 * signature keyboard Clear Signature - Investor 2 * signature keyboard Clear Date * Time * 00:0000:3001:0001:3002:0002:3003:0003:3004:0004:3005:0005:3006:0006:3007:0007:3008:0008:3009:0009:3010:0010:3011:0011:3012:0012:3013:0013:3014:0014:3015:0015:3016:0016:3017:0017:3018:0018:3019:0019:3020:0020:3021:0021:3022:0022:3023:0023:30 For Office Use Only signature keyboard Clear For Office Use Only - Referral Code If you are human, leave this field blank. Submit
