公司客戶盡職審查表格 (Corporate Customer Due Diligence Form)

公司全名 (English) :

註冊國 (Registered Country) : 電話 (phone) :

電郵 (email) :

地址 (Registered Address) :

銀行名稱及帳號 Bank

Name/Aaccount :

香港有限公司 Hong Kong Company Limited

☐ 商業登記證 Certificate of Business Registration

☐ 最新公司查冊 Latest Company Search

香港非有限公司 Hong Kong Company

☐ 商業登記證 Certificate of Business Registration

☐ 其他文件(如合伙契約、會籍等) Other documents (e.g., partnership deed, association membership etc.)

海外公司 Foreign Company

☐ 其他 Others (文件 doc. type) ：

☐ 其他 Others (文件 doc. type) ：

☐ 其他 Others (文件 doc. type) ：

文件過期 Document expired? Y ☐ / N ☐

行業資料 Occupation Details

☐ 名錶、鑽石、黃金、珠寶

Expensive watch, diamond, gold, jewelry ☐

外幣/找換代理、送款代理

FX/remittance agents, cash on delivery

☐ 賭博 Casino / gambling ☐ 名車、遊艇、古董、其他奢侈品 Expensive car, yacht, antique, other luxury goods

☐ 以上皆否 None of the above ：

資金來源 Source of Funds

☐ 業務(售貨/服務)收入 Business revenue of good/service sale ☐ 日常營運涉及兌換外幣 FX relating to daily business

☐ 資金不涉及貨物或服務銷售

Funds irrelevant to sales of goods/services ：

資金用途 Funds Use

☐ 日常營運涉及兌換外幣 FX relating to daily business ☐ 處理業務/投資利潤 Handling business/investment profit

☐ 履行契約/借款 Enforce contract/loan agreements ☐ 賬單/貨單支付 Bills/invoices settlement

☐ 人工支付 Salary payment ☐ 其他 Others ：

公司主要生意伙伴所在地 Countries where Customers major partners located

主要供應商所在地

Countries where major suppliers are located ：

主要客戶所在地

Countries where major clients/buyers are located ：

客戶聲明及授權書

Declaration and Letter of Authorization for Partnerships and Unincorporated Bodies

We (or the Company) hereby certify that we have made the following decisions in the manner duly compliance with the constitution of our company, and that no action has been taken to rescind or amend the said decisions and that the same are now in full force and effect:

我們 (或本機構)謹確認作出如下決定，該決定是在完全符合本機構之章程規定下所作出，並無任何人採取任何行動撤消或修改該

決定，而該決定正式全面生效： 1) A business relationship would be established with Ria Exchange Limited (“RIA”) to engage RIA for its foreign currency exchange and/or

remittance services.

本機構與 Ria Exchange Limited（“RIA”）建立業務關係以申請外幣兌換及匯款服務。 2) For the purpose of paragraph 1 above, we confirmed that the name of beneficial owners and their respective identity information and

correspondence addresses were listed below (Beneficial owners were those who were entitled to, directly or indirectly, not less than a 25%

share of the capital or profits, or a 25% of the voting rights or exercising ultimate control of us):

為上述第一段之事宜，本機構確認本機構之實益擁有人及其各自的聯絡地址如下(實益擁有人即直接或間接地持有本機構不少

於百分之廿五的資本或盈利、或百分之廿五或以上的本機構投票權或對本機構操有最終控制權的人士) :

Beneficial Owner Name

實益擁有人姓名

Correspondence Address

聯絡地址

Copy of Identity

Document?

身份證明文件副本?

1

Y ☐ / N ☐

2

Y ☐ / N ☐

3

Y ☐ / N ☐

4

Y ☐ / N ☐

3) For the purpose of paragraph 1 above, we confirmed that the identity information of the connected parties were listed below (a connected

party was the director, partner, trustee of the Company):

為上述第一段之事宜，本機構確認本機構之關聯人士身份資料如下(關聯人士為本分司的董事、合伙人或信託人) :

Connected Party Name

關聯人姓名

Correspondence Address

聯絡地址

Functions

身份

Copy of Identity

Document?

身份證明文件副本?

1

☐ Director/ Partner 董事/合伙人

☐ Trustee 信託人 Y ☐ / N ☐

2

☐ Director/ Partner 董事/合伙人

☐ Trustee 信託人 Y ☐ / N ☐

3

☐ Director/ Partner 董事/合伙人

☐ Trustee 信託人 Y ☐ / N ☐

4

☐ Director/ Partner 董事/合伙人

☐ Trustee 信託人 Y ☐ / N ☐

4) For the purpose of paragraph 1 above, we authorized the following individual(s) (the “Authorized Persons”) to act for and on behalf of us, and to give oral and/or written instruction(s) to RIA for our remittance and/or foreign currency exchange services. Any instruction(s)

given by the Authorized Persons shall be absolutely binding on us. We accepted full responsibility for all oral and/or written instruction(s) given by the Authorized Persons on our behalf. RIA shall have no obligation whatsoever to inquire about or confirm the authority of the Authorized Persons in giving any instructions. We agreed to indemnify RIA, its employees and stakeholders against all reasonable losses or damages on account of the transactions conducted by RIA upon the instruction from the Authorized Persons.

為上述第一段之事宜，本機構已授權下列人士 (“獲授權人”) 代表我們行事，並向 RIA申請匯款和／或外幣兌換服務發出口頭

或書面指示，該等獲授權人作出的任何指示對本機構具有絕對的約束力，本機構必需對該等獲授權人發出的全部口頭或書面

指示負上全部責任。RIA毋須查詢或核實獲授權人發出任何指示所依據的權力。本機構同意向RIA、RIA之員工及持份者因接受

和處理獲授權人士指示所引致的合理損失。

Authorized Person

Name

獲授權人姓名

Correspondence Address

聯絡地址

Specimen signature(s) to effect

transaction

簽名樣式

Copy of Identity

Document?

身份證明文件副本?

1

Y ☐ / N ☐

2

Y ☐ / N ☐

3

Y ☐ / N ☐

4

Y ☐ / N ☐

5) The details of the beneficial owners and authorized persons shall remain in full force and effect unless and until RIA receive written notice

of amendment from us, such amendment would not release the us from any liability in respect of any act performed by RIA prior to the receipt of the notice of amendment.

除非 RIA收到本機構的書面更改通知通告，實益擁有人和獲授權人的資料一直維持有效，而 RIA在收到該書面更改通知前根

據本文件所作之任何行動亦由本機構負責。

私隱聲明(Privacy Statement) As the “Data Subject” of this Form, your data will be kept confidential and handled according to the Personal Data (Privacy) Ordinance except the following reasons / 閣下作為本表格的「資料當事人」，我們會

將你的資料根據《個人資料（私隱）條例》處理和保管。但我們會使用和披露的你資料作下述用途：

1) assessing your suitability for our remittance and foreign exchange services/評估閣下使用我們滙款及外幣兌換服務之適合性；

2) enabling us to provide you with remittance and foreign exchange services/使我們能為閣下提供滙款及外幣兌換服務；

3) checking and monitoring your money service transactions conducted through our company/檢查及核對閣下經我們進行的金錢服務交易；

4) promoting services provided by our company and our group companies/推廣我們及集團公司的其他產品及服務；

5) disclosing and using your data subject to the obligations under laws and requirements applicable to us/披露及使用閣下的資料以符合適用法律及要求：

i. any laws binding within or outside Hong Kong 香港境內及境外適用的任何法律

ii. any guidelines issued by regulatory, governmental or enforcement authorities 香港境內及境外任何監管、政府、執法機構發出之任何指引

6) Fulfilling our company and/or our group companies’ internal policies regarding anti-money laundering, counter-terrorist financing and prevention of any criminal activities 符合本公司或成員公司反洗

錢、打擊恐怖份子資金籌集或防止任何不法活動的內部政策;

7) maintaining subject data’s information and transactions for present and future reference (whether or not there exists any relationship between data subjects and the Company); and保留資料當事人的資

料及交易記錄，不論資料當事人與本公司是否存在任何關係，以作現在或將來參考之用

8) purposes incidental, associated or relating to paragraphs above 與上述段落有聯繫、有附帶性或有關的用途。

You may opt-out of receiving our marketing messages (pursuant to paragraph 4 above) at any time by sending us email. Within 10 working days upon receiving your notice, we shall formally acknowledge receipt and cease sending you any relevant materials. If you have any enquiries in relation to this Statement, or if you want to request access and correct our record of your information, please send your request in

writing to us. We may charge an administrative fee of $50.00 per request. 閣下可在任何時間給本公司電郵作出“停止接受直銷”（根據上述第 4 點）的要求。我們會在十個工作天內接納你的要求並停止

向閣下發出直銷有關資訊。如閣下對本私隱聲明有疑問或須要查詢及更正我們對你資料的紀錄，請以書面形式向我們提出申請。我們可能會對每項查申請收對$50 作為行政費用

客戶填寫部份(Part completed by Customer) 本人茲聲明載於本表格及交予 RIA Exchange Limited（“貴公司”） 的資料均是屬實、完整及最新的。如有任何文件缺漏，本人將馬上按要求補交缺漏的文件。如有任何更新，本人會馬上向貴公司提出

通知。本人同意自己有責任採取任何需要的行動以幫助貴公司符合《反洗黑錢及打擊恐怖分子融資（金融機構）條例》（“反洗錢法”）及一切有關反洗黑錢及打擊恐怖分子融資之法例和法定要求。貴

公司有權收集、使用及披露任何與本人有關的資料、或與本人向貴公司申請之交易有關的資料(包括向執法機關作出披露)，以符合反洗錢法及一切有關反洗黑錢及打擊恐怖分子融資之法例及法定要

求。本人及本人與貴公司之交易與任何洗黑錢、恐怖活動、恐怖分子融資以及任何犯罪活動無關。如貴公司因與本人建立業務關係或因處理任何一宗由本人直接或間接申請之交易而招致損失、損害、

費用(包括法律費用)或申索，本人將向貴公司、貴公司之員工或持份者作出賠贘。

I hereby declare that all the information provided to RIA Exchange Limited (“RIA”) in this Form is true, complete and up-to-date. I shall provide RIA with any missing documents without delay. I shall notify RIA of any

change in my information without delay. I agree that I am obliged to take all necessary actions to assist RIA fulfilling the requirements under Anti-Money Laundering and Counter Terrorist Financing (Financial Institutions)

Ordinance (“AMLO”) and all relevant ordinances and regulatory requirements of anti-money laundering and counter terrorist financing (“AML” and “CFT”). RIA can collect, use and disclose (including disclosure to the

governmental agencies) any and all information relating to me and any transactions conducted by RIA applied by me for the purpose of complying with the requirements of the AMLO and all other ordinances and regulatory

requirements of AML and CFT. I and the transactions between RIA and I are irrelevant to any money laundering, terrorist activities, terrorist financing or any unlawful activities. I shall indemni fy and keep RIA, its employees

and stakeholders indemnified against all the losses, damages, costs (including legal fees) and claims which RIA may suffer or incur as a result of establishing business relationship with me or conducting any transactions upon

my direct or indirect instructions.

關於上述的個人私隱聲明（Referring to the Privacy Statement indicated above）

□ 本人表示明白及同意（I declare that I understand and agree with it）

客戶簽署（Signature of the customer）

日期 (Date)

For Office Use Only 公司專用

員工姓名

Staff Name

合規主任姓名

Name of Compliance Officer

員工簽署

Signature of staff

合規主任簽署

Signature of Compliance Officer

合規主任意見 Advice of Compliance Officer:

跟進行動 Follow up actions

進行高風險客戶進一步盡職審查-（持續監察/不尋常交易報

告）

□ 是 Yes □ 否 No

可疑交易報告 STRs to JFIU □ 是 Yes □ 否 No

Add: Room 1113, Tower B, Hung Hom Commercial Centre, 37 Ma Tau Wai Road, Hung Hom, Hong Kong.

Email: sailesh@riaexchange.com enquiry@riaexchange.com Telephone: (852) 3157 1523 – 24 Fax: (852) 3157 1525