SCOPE / OBJECTIVE

The questionnaire will be asked to the User/Client that completed the KYC Verification, whereby the
User will have to disclose their source of funds along with appropriate documentation required.

S.No. Proof of Funds questions to be asked to our User / Client

1. EMPLOYMENT STATUS
1.1. Kindly state your employment status. *

☑ Employed ☑ Self-Employed/Entrepreneur ☑ Student ☑ Retired ☑

Unemployed

1.2. If Self - Employed/Entrepreneur, what is the Nature of your Business*

Please specify:
Trabajo como independiente en una empresa de grasas alimenticias

1.3. If Employed, what is your Current Job Role?*

Please specify:

En una empresa de grasas alimenticias pero como independiente

2. NET WORTH / FINANCIAL STATUS
2.1 What is your total es mated net worth?*

Less than USD 20,000 If Other, please specify:

Es menos de USD 20.000

2.2. If Employed or Self Employed/Entrepreneur, what is your Total Annual Income?*

Please specify:

Trabajo como independiente en una empresa prestando el servicio USD 9.500

2.3. Kindly chose the Proof of Income from the below check box op on*

☑ Bank Statement for the Last 6 months ☑ Employer Pay Statement

☑ Tax Payment Form ☑ Crypto Wallet Statement ☑ Online Trading Wallet
Statement
☑ Other
If Other, please specify:

Pago en efectivo, no se entrega comprobante de pago

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 Please a ach the selected Proof of Income (Uploading Op on)

2.4. If Unemployed / Re red / Student, what is your Total Annual Income?*

Please specify:No aplica

2.5. Kindly chose the Proof of Income from the below check box op on*

☑ Bank Statement for the Last 6 months ☑ Tax Payment Form

☑ Crypto Wallet Statement ☑ Online Trading Wallet Statement
☑ Other
En efectivo sin comprobante de pago
If Other, please specify _____________
Please a ach the selected Proof of Income (Kindly upload this le)

2.6 Any other Source of Fund you wish to declare.

☑ Sale of Property ☑ Inheritance of Wealth or Funds

☑ Other
If Other, please specify:

* Required to ll No aplica
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 Addi onal Ques ons on the basis of the withdrawal amount:-

● On the basis of the Total Annual Income and the type of Category the Users fall into they will
have to ll up the addi onal documents.
● The below informa on is what the Users will receive:-

For Broker Group Ltd to comply with the global AML (An Money Laundering) Regula ons and
Legisla ons, it is mandatory for the Applicants to provide us with the below details which will assist us in
understanding how you have acquired your funds or wealth.

S.No. Addi onal Proof of Funds Ques ons

1. If Employed / Self-Employed

1.1. In the descrip on box kindly provide the origin and source of your wealth.*

(Text Box)

Sobre la capitalización de la inversión realizo retiros de las ganancias y sobre las pocas
personas que ingresan se gana comisión bajo su porcentaje.

1.2. Do you receive any bonuses?*

☑ Yes ☑ No.
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 On the basis of the above selected op on please a ach the suppor ng document
⬇ (Uploading Op on)
● Self Employed/ Entrepreneurs - Copy of recent nancial statement / tax statement /
crypto statement.
● Employee - Copy of the Bonus Pay Slip in the company le er head and the company
stamp.
● For all - Bank statement displaying the most recent income earned.
1.3. Sale of any asset or property?*

☑ Yes ☑ No.

If yes, please provide the suppor ng document. (Kindly upload this le)

1.4. Ownership of any valuable property or asset (Shares, bonds, etc.)?*

☑ Yes ☑ No.

If yes, please provide the suppor ng document. (Kindly upload this le)

(Text Box)

1.5. If you have other source of income please specify:-*

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 (Text Box)

No tengo otra fuente de ingreso

1.6. Kindly provide a brief descrip on about the ac vity or services provided by your company.*

(Text Box)

Brindo servicio de transporte de gradas alimenticias para la empresa, pero siendo prestador
de servicio.

1.7. If your business is related to any one of the following business ac vi es, as per the AML
(An Money Laundering) Regula ons and Legisla on, we will require addi onal
documenta on.
1. Law Firm or Legal Consultancies
2. Accoun ng or Audi ng Firm
3. Dealers of precious stones and metals
4. Corporate Service Providers
5. Real Estate Dealers
6. Casino, gambling or be ng industry
7. Money Exchange House
Please provide the below addi onal company documenta on:-*
☑ Trade License of the Company ☑ Ar cle / Memorandum of Associa on
☑ Directory Register ☑ Bank Statement of the Company
☑ Ul mate Bene cial Owner Cer cate / Declara on
* Required to ll No tengo negocios relacionado a lo mencionado
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 S.No. Addi onal Proof of Funds Ques ons
1. If Unemployed / Re red / Student

1.1. In the descrip on box kindly provide the origin and source of your wealth. *

Text Box:

Trabajando como independiente en una empresa, siendo prestador de servicios

1.2. If Re red, do you receive a monthly pension or re rement income? *

☑ Yes ☑ No.

If yes, please provide the suppor ng document. (Kindly upload this le)
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1.3. If Unemployed/ Student, did you receive any inheritance money?*

☑ Yes ☑ No.

If yes, please provide the suppor ng document. (Kindly upload this le)

1.4. Sale of any asset or property?*

☑ Yes ☑ No.

If yes, please provide the suppor ng document. (Kindly upload this le)

1.5. Ownership of any valuable asset or property?*

☑ Yes ☑ No.

If yes, please provide the suppor ng document. (Kindly upload this le)

1.6. Have you made any prior investment(s) in company(ies)/ funds?*

☑ Yes ☑ No.

If yes, please provide the suppor ng document. (Kindly upload this le)

1.7. If you have other source of income please specify:-*

Text Box:

No tengo otra fuente de ingresos

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 1.8. If your investment in a company(ies) is related to any one of the following business
ac vi es, as per the AML (An Money Laundering) Regula ons and Legisla on, we will
require addi onal documenta on.
8. Law Firm or Legal Consultancies
9. Accoun ng or Audi ng Firm
10. Dealers of precious stones and metals
11. Corporate Service Providers
12. Real Estate Dealers
13. Casino, gambling or be ng industry
14. Money Exchange House
Please provide the below addi onal company documenta on:-*
☑ Trade License of the Company ☑ Ar cle / Memorandum of Associa on
☑ Directory Register ☑ Bank Statement of the Company
☑ Ul mate Bene cial Owner Cer cate / Declara on
* Required to ll
No tengo empresa con relación a lo mencionado
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