Individuals m if Id
Individuals m if Id
Postal address: P.O. Box 867 - L-2018 Luxembourg Telephone: +352 45 49 45 1 Swift address: www.dnb.no/lu
Visiting address: 13 rue Goethe, L-1637 Luxembourg Telefax: +352 45 49 45 200 UBNLLULLXXX
Insider information
Do you have access to privileged financial information (inside information), e.g. due to your profession or
relationships, or are you subject to any investment restrictions?
Yes No
Yes No
If yes, please specify which
country and position:
Insider information
Do you have access to privileged financial information (inside information), e.g. due to your profession or
relationships, or are you subject to any investment restrictions?
Yes No
What is the main intended purpose of the account? (please check one or more boxes, as applicable)
Private banking services Mortgage loan
MIFID questionnaire
This MiFID questionnaire must be completed, in order for the Bank to understand your individual needs
and circumstances so that it can recommend the right products for you. This is typically the case if you
request private banking or brokerage/custody services. To obtain that understanding, questions covering
three areas must be answered as clearly as possible: i) your financial situation, ii) your knowledge,
experience and interest in the financial markets, iii) your investment objectives and risk tolerance.
If you need assistance, please do not hesitate to discuss this with one of our Account Managers. All your
answers will be treated with strict confidentiality.
Understanding your current financial situation is important when preparing our investment proposal. Your
finances and commitments should be able to bear the potential investment risks of your portfolio. If the
level of your liquid assets is too low to cover any short term needs you may have, our proposal would
typically be more conservative.
Information and a general overview of your net wealth or how high your liabilities are compared to your
assets.
The objective is to understand the ratio between assets and liabilities. In your asset base you should
include cash, securities, real estate and other investments. The liabilities should include any debt
connected to property or financial assets and any other debt (consumer debt).
Understanding your personal and professional knowledge and experience as an investor will help us
assess which products you may or may not be familiar with.
What is your investment knowledge and experience? (check one box only)
I have no investment knowledge: I never follow the financial news and markets.
Basic knowledge: I follow the markets occasionally and understand the difference between basic, non
complex products, such as shares, bonds etc.
Average knowledge: I have invested before and am aware of the different investment possibilities
such as shares, bonds, commodities etc. and the varying risk levels.
Above average knowledge: I am an active investor in the markets. I am aware of and have invested in
different investment possibilities such as shares, bonds, commodities etc. I am aware of the
associated risks.
Extensive knowledge: I am financially qualified, have a professional background and a thorough
understanding of the investment products and strategies.
Do you have investment experience from any of the following product categories?
None: You have not traded in financial instruments over the last three years.
Have traded: You have made transactions with financial instruments over the last three years, but not to
the same extent as an “active trader”.
Active trader: You have carried out significant transactions on the relevant market at an average
frequency of ten per quarter over the previous four quarters.
Time deposits
Bonds
Shares
Cash and bonds funds
None Have traded Active trader
Share funds
Hedge funds
Foreign exchange
Derivatives (options, futures)
Leverage investments (e.g. through loans)
Please note that the Bank may not necessarily be able to offer all products listed above.
The purpose of this section is to establish your investment objectives. Therefore it is important to
consider your cash flow needs, your expectations and time horizon. This part of the questionnaire also
seeks to provide a good understanding of your risk tolerance. Always consider adjusting your risk
tolerance based on your personal response to risks when determining your ideal asset allocation.
Accepting a higher degree of risk for the investments implies the possibility of achieving higher long term
returns, but also a probability of short term losses.
What is your investment horizon, i.e. the period during which you are unlikely to need to withdraw the funds
placed with us? (check one box only)
Less than 1 year 1-2 years 3-4 years 5-10 years More than 10 years
How would you describe your risk appetite? (check one box only)
I do not want to take any financial risks and wish to preserve my capital at all times.
I am very concerned about taking risks. I prefer lower returns to reduce the probability of loss although
I understand it can occur even with traditional low(er) risk investments.
I am willing to accept a moderate risk and the probability of some losses in order to achieve higher
returns.
I understand how investing works and its associated risks. I could extend my investment horizon in
pursuit of higher returns or to recoup investment losses.
I wish to achieve high returns on my investments. I am willing to accept a high risk and the probability
of a substantial loss. I can easily extend my investment horizon and/or top up my investments in
pursuit of greater returns.
How would you react if your investment portfolio fell significantly in value over a one-year period?
(check one box only)
I would sell all my investments immediately and place the proceeds into a savings account.
I would sell parts of my investments and place the proceeds in an alternative investment strategy.
I would wait until I have recovered my loss and then consider an alternative investment strategy.
I would remain invested and continue to follow my investment strategy.
I would increase the amount invested.
What is your maximum loss tolerance for any one year? (check one box only)
Under 5% 5 - 10% 10 - 20% Over 20%
Your answers to the questions in this MiFID questionnaire will determine your investor profile, which will
be classified as Conservative, Neutral or Aggressive (see definitions below).
If you fill in the questionnaire on-line, our system will provide you with the results and determine your
investor profile. However, if you fill in the questionnaire in writing the Bank will assess it, determine your
investor profile and inform you in writing.
Should you disagree with the investor profile assigned to you, please contact your Account Manager, or
readdress the on-line application form and adjust your profile according to your personal expectations.
When the questionnaire has been submitted to the Bank or no remarks been given to allocated investor
profile the Bank will consider you to be in agreement with that profile and use it as a basis when providing
you with any type of investment advisory services. You will always have the possibility of contacting your
account manager in order to adjust your investor profile, be it as a result of changes in your personal
expectations, your financial circumstances, or any other reason.
In a range from -100% (meaning highly conservative) and +100%
(meaning highly aggressive), your computed score is:
Conservative (-100% to -25%)
As a Conservative investor, we expect security and capital protection to be important to you. You are
mostly willing to invest in low-risk financial instruments, and wish to avoid large volatility in the returns
from your portfolio. This does not prevent you from once in a while considering investing in “prudent”
shares and/or similar instruments, potentially through funds.
The Bank will use your investor profile for all accounts you hold with it. All joint account holders and/or
beneficial owners of assets are also deemed to agree to the information provided and the related profile.
If you do not provide the information required above, the Bank can not determine your investor profile. As
a result, the Bank can not provide you with investment advice or portfolio management services, nor will it
be in a position to determine if other products and services that it makes available are suitable or
appropriate for you. As a consequence, when requesting products and services from the Bank you accept
the risk that such products and services may not be appropriate for you.
I/we hereby confirm being the actual beneficial owner(s) of the account, and that consequently all funds
deposited in the account are mine/ours. I/we confirm, declare and certify that the funds do not and will not
originate, directly or indirectly, from criminal activities.
What is the “economic” source of the assets to be transferred to the Bank? (How did you originally
accumulate these funds?)
Please check the applicable boxes and enter further explanations on the origin of the assets (please check at least one
box).
Savings Inheritance Sale of real estate
Insurance Commissions Salary / Employment income Other
Please specify
What is the “geographic” source of those assets? (From which bank and country will they be
transferred?)
Cash Securities
What will be the amount and "format" (cash and/or securities) of the initial transfer to the account in
EUR?
Cash Securities
What is the expected total size of assets to be invested through the account in EUR?
The account is opened on behalf of a third party who is the ultimate beneficial owner of the
account. Please use the additional form “Beneficial ownership of funds statement”.
This could apply in circumstances where the account is meant to hold third–party funds, temporarily
placed under your control as a result of your profession (lawyer, notary, real estate agent etc.).
I/we understand and acknowledge that according to various laws or operational practice in different
jurisdictions, including but not limited to Norway, nominee registration of securities is not permitted or
require specific reporting/disclosure obligations. Hence, I/we herewith authorise the Bank, where required
by legal or operational requirements, to open in my/our name a segregated account (sub-account) with its
custodian bank, where respective securities, including but not limited to Norwegian shares and
investment fund units, held on my/our behalf will be deposited in my/our name.
Reduced withholding tax rates. (please check one of the boxes to indicate your choice)
No, I/we would not like to benefit from reduced withholding tax rates.
I/we hereby notify the Bank that I/we would like to benefit from reduced withholding tax rates on
dividends/income from securities, provided that an applicable double taxation treaty is in force
between the country of the issuer of a security and my/our country of tax residence. Hence, I/we
instruct the Bank to apply for reduced withholding tax on my/our respective holdings.
I/we hereby declare that I am/we are entitled to benefit from the tax treaties entered into force and
signed by my/our country of tax residence, and confirm that I am/we are the sole beneficial owner(s)
of the funds/holdings to be deposited, now and in the future, into the custody account to be opened in
my/our name.
I/we acknowledge that in order to benefit from a reduced withholding tax rate it is mandatory to
provide a certificate of fiscal residence (Tax Residence Certificate). I/we acknowledge that failure
to provide/renew required documents will make it impossible to apply reduced withholding tax rates.
I/we acknowledge that the reduced withholding tax rate service is not available in all markets and is
subject to licenses and/or agreements the Bank has entered into and other technical arrangements
and will be provided on a best-effort basis. I/we also acknowledge that this service only applies to
cross-border holdings.
Note: Norwegian clients (tax residency in Norway) are not required to provide a certificate of fiscal
residence.
The above mandates are given in order to allow the Account Holder to invest in particular securities in
conformity with the relevant local laws, regulations and applicable double taxation treaties which require
such disclosure, and to obtain reduced withholding tax rates. These specific mandates waive the Bank
from its professional secrecy duty when disclosing the above-mentioned information. The Account Holder
fully understands and acknowledges that providing the Bank with such a mandate and communicating
the information to the relevant authorities or its sub-custodians might result in this information also being
provided to certain third parties under the laws of the countries invested in. The Account Holder hereby
acknowledges having been duly informed by the Bank about this and will not hold the Bank liable for any
consequence deriving directly or indirectly from its performance of this specific mandate.
EU Savings Directive
EU Savings Directive – Exchange of information (Individuals who are tax residents in the EU,
Luxembourg excepted).
I/we hereby acknowledge that the Bank, when acting in its capacity as paying agent within the terms of
the Luxembourg law dated 21st June 2005 transposing EU directive 2003/48 on taxation savings income
in the form of interest payments, will provide the Ministry of Finance of the Grand Duchy of Luxembourg
or its authorised representative the following information:
- My/our name and permanent resident address;
- My/our account details;
- All amounts of interest–related income paid/credited to the account over the preceding year.
I/we acknowledge that the Ministry of Finance of the Grand Duchy of Luxembourg or its authorised
representative will automatically pass that information on to the competent authority of my/our country of
residence at least once a year, no later than the 30th of June of the year following the year of declaration.
Unless written notice is given to the contrary, the Bank is authorised to act on all instructions received
from me/us in writing, by fax or phone with regard to my/our account. Written or faxed instructions must
be duly signed. This authorisation also includes those who act on my/our behalf and have been notified in
writing to the Bank as authorised by me/us.
The Bank automatically records all incoming and outgoing telephone calls.
The Bank will normally communicate with you through the means indicated above. The Bank does not
consider e-mail communication a secure way of communicating. However, if you wish to communicate by
e-mail you hereby authorise the Bank to send you at your entire risk, information which may be of a
confidential nature to an e-mail address provided by you, including but not limited to account statements.
If doing so, you also understand and acknowledge that such requests may include communication of data
related to the account, personal data or any data within the scope of provisions on professional secrecy.
The Bank recommends that you use your e-mail in your secured webmail function, which is provided for
in the e-banking services.
No, I/we do not wish to communicate with the Bank by e-mail (indicate by checking the box or not).
By signing the account opening application the Bank provides you with access to banking services via its
internet site.
The Bank shall provide the Account Holder with all items required to access the e-banking services, as
defined hereinafter.
Services: The Account Holder will initially be entitled to access the following services (hereinafter
referred to as the “E-banking services”):
- Access to account statements
- Money orders / money transfers
- Webmail services.
The Bank may update the list of e-banking services offered at any time. The Account Holder will be
informed by a webmail message.
Please confirm agreement with the statements below by dating and signing your application and
checking all the boxes.
I/we hereby acknowledge having received, read and understood a copy of and agree with the Bank’s
“General Terms and Conditions of Business” (GTC), the Bank’s “E-banking services - Terms and
Conditions” and applicable Pricelist which shall govern all my/our relations with the Bank, unless
otherwise specified by specific instructions. Joint account holders specifically confirm having read and
understood clause 3 of those GTCs. I/we acknowledge having, at any given time, access to the GTCs,
the “E-banking services – Terms and Conditions” and the “Framework to payment services” on the
Bank’s website: www.dnb.no/lu.
I/we acknowledge that the information to be provided in relation to holdings in cross-border securities,
reduced withholding tax and/or exchange of information subject to the EU savings directive generally
consists of some or all of the following elements: the securities owner’s name, address, country of tax
residence, date of birth and tax identification number (alternatively social security number in some
countries or company identification number), name of the securities (issuer) invested in, holding/
participation, income amount and tax withheld.
I/we undertake to immediately notify the Bank of any changes to the information I/we have provided,
including but not limited to my/our personal details of the beneficial ownership, confirm that the
address stated in the account opening form is my/our residence for tax purposes, and that I/we are not
resident for tax purposes in any other country. I/we undertake to provide the Bank with an updated
certificate of fiscal residence as applicable.
I/we moreover acknowledge that it is my/our responsibility to assess and fulfil any reporting
obligations I/we may have towards the (tax) authorities of my/our country of (tax) residence regarding
the assets deposited with the Bank and the income derived thereof.
Date Place
___________________________
___________________________
In case of a joint account, the right to operate the account shall be as follows:
Each Account Holder may instruct/sign alone.
All Account Holders must instruct/sign jointly.
Other instruction/signing rules.
Please specify
A certified* copy of the passport for each Account Holder, beneficial owner(s) (if different from Account
Holders) and holders of power of attorney if any (Power of attorney).
A certified copy or original proof of residency (tax residency certificate) less than 6 months old for
Account Holders who wish to benefit from reduced withholding tax rates and for EU citizens residing
outside the EU.
*Documents can be certified by your account manager if he/she has seen the originals, by an authorised
DNB Group employee, a competent authority (notary, police, embassy etc.) or financial institution subject
to equivalent regulations to combat money laundering and terrorist financing.
Should you have any questions regarding the completion of this form or required attachments,
please do not hesitate to contact the Bank.