Uptimus Smart Technologies Ltd

earndiamonds

Upload Passport *

PERSONAL DATA DATE

Title: Mr. Mrs. Miss Others

Name of Investor(s):

Date of Birth:

Gender M F

State of Origin:

L.G. Area:

Nationality:

Mobile No:

e-mail:

Occupation: (if business, please state the type of business)

Residential Address: (Street Number)

International Passport ID No:

Issue Date:

Expiry Date:

Next of Kin:

Gender M F

Date of birth:

Purpose /Reason for opening the account:

Source of Income:

Type of Share purchased

Regular Diamonds: Brokers Diamonds

Number of Diamonds:

DECLARATION

I declare that all the information submitted in this application form is correct and complete. I acknowledge that Uptimus Smart Technologies Ltd reserves the right to vary or reverse any decision regarding approval on the basis of incorrect or incomplete information provided by me. I declare further that I had read & understood all contents of this application form & agreement and that I am bound by all their contents for all purpose. Furthermore, I agree to notify the Uptimus Smart Technologies Ltd of any changes to the required information within 30 days of such change.

Applicant Signed:

Earn Diamond