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Cis Form Blank Rev. 1.0

The document is a client information sheet for Ezra Njagi Njeru, a Kenyan citizen, outlining personal and business details for compliance with anti-money laundering regulations. It includes information such as passport details, contact information, and an estimated business value of USD 2.2 billion. The document also contains a declaration affirming the accuracy of the provided information and compliance with financial regulations.

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4 views

Cis Form Blank Rev. 1.0

The document is a client information sheet for Ezra Njagi Njeru, a Kenyan citizen, outlining personal and business details for compliance with anti-money laundering regulations. It includes information such as passport details, contact information, and an estimated business value of USD 2.2 billion. The document also contains a declaration affirming the accuracy of the provided information and compliance with financial regulations.

Uploaded by

wambani kev
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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CLIENT INFORMATION SHEET

In accordance with Articles two (2) through five (5) of the Due Diligence Convention and the Federal Marketing Commission
No. Circular of December 1998, concerning the prevention of money laundering, the following information may be supplied to banks
and/or other Federal Institutions for purposes of verification.
Date: Friday, 30 May 2025
1 Client Name Ezra Njagi Njeru
Citizenship Kenyan
Passport Number BK143413
Passport Issue Country / Expiration Date Kenya / 17 June 2031
Federal ID Number N/A
Date of Birth 1 January 1990
Email Address [email protected]
Address / Telephone Pumwani, Nairobi, Kenya
2 Business Name Private
Business Address
Registered Office
Registration Number
Business Fax Number
Business Phone Number
Email Address
3 CONTENTS TBA
Number of Pallets 20
Number of Boxes 80
Location of Pallets Kampala, Uganda
Weight per Box 260kgs

4 ESTIMATED VALUE USD 2.2 Billion


5 Advisor Details Jaya Naicker
Advisor to Owner Telephone Number + 2771 409 6879

CIS FORM Rev.1.0 – CICC Council of International Chambers of Commerce 1


Declaration:
I hereby swear under penalty of perjury, that the information provided herein is accurate and
true. All monies engaged in this transaction are derived from non-criminal origin; and, are good,
clean and cleared. The origins of funds are in compliance with Anti-Money-Laundering Policies
as set forth by the Financial Action task Force (FATF) 6/01.

____________________
Authorized Signature

DATE: Friday, 30 May 2025


Name: Ezra Njagi Njeru
Title: Owner
Passport Number: BK143413
Country of Issue: Kenya
Issue Date: 08 June 2021
Expiry Date: 07 June 2031

CIS FORM Rev.1.0 – CICC Council of International Chambers of Commerce 2


APPENDIX 1: DIRECTOR/SIGNATORY PASSPORT

CIS FORM Rev.1.0 – CICC Council of International Chambers of Commerce 3


APPENDIX 2: COMPANY REGISTRATION CERTIFICATE

CIS FORM Rev.1.0 – CICC Council of International Chambers of Commerce 4


APPENDIX 3: COMPANY INCORPORATION CERTIFICATE

CIS FORM Rev.1.0 – CICC Council of International Chambers of Commerce 5

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