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Know Your Clients – Assessment Form2025-09-17T09:51:01+00:00

Know Your Clients – Assessment Form

"*" indicates required fields

1Details

2Work Information

3Declaration

Email*

Property / Development Name*

Unit / House Number*

Full Name and Surname*

ID / Passport Number*

Contact Number

Please select your agent*

Applicant Entity*

What is your main occupation or business activity*

PLEASE SPECIFY

Occupation / Occupational level?*

Trust Name*

Trust Registration Number

Income Tax Number*

Marital Status*

Married

Not Married

Type of Marriage*

ANC

COP

Company Name*

Company Registration Number*

Income Tax Number*

What is your main source of funds for this transaction?*

Allowances

Bursary

Company Profits

Company sale

Court order

Deceased Estate

Divorce settlement

Gift donation

Income from Employment

Income from previous employment

Inheritance

Loan (Financial institutions)

Loan (Other)

Lottery / Winnings / Gambling

Maintenance

Maturing investments

Pension

Rental income

Sale of Asset

Sale of Shares

Trust Distribution

BUSINESS STRUCTURE INFORMATION*

EXECUTIVE MANAGEMENT AND CONTROL: Please list all natural persons who have Executive Control of the Company (e.g. CEO, CFO, COO,CMO,CTO Executive Management Staff, etc.)

Name and Surname:

ID / Passport Number:

Residential Address:

Designation Type:

Contact Number:

Email Address:

SHAREHOLDING*

Please list all Shareholders with a shareholding of 5% or more.

Name and Surname:

ID / Passport Number:

Residential Address:

Shareholding (%):

Contact Number:

Email Address:

IF SHARES ARE ISSUED TO OTHER LEGAL ENTITIES, PLEASE LIST THE OTHER ENTITIES’ SHAREHOLDING AND SUPPLY AN ORGANOGRAM FOR THE OWNERSHIP STRUCTURE

*** Please note that all shareholding companies/close corporations must disclose their own shareholding and ownership structures separately ***

ULTIMATE BENEFICIAL OWNERSHIP

If different to the Executive Management, and Ownership above, please list the natural person/s who ultimately owns the Company or exercises Effective Control over it either directly, through an ownership structure or as a Donor, Trustee or Beneficiary

Name and Surname:

ID / Passport Number:

Residential Address:

Shareholding (%):

Contact Number:

Email Address:

THE TRUSTEES*

Please list all Trustees, together with their particulars

Name and Surname:

ID / Passport Number:

Residential Address:

Contact Number:

Email Address:

THE NAMED BENEFICIARIES*

Please list all named, or determinable beneficiaries:

Name and Surname:

ID / Passport Number:

Residential Address:

Shareholding (%):

Contact Number:

Email Address:

THE INDIVIDUAL

Physical Address*

Email Address*

Income Tax Number*

I hereby declare that the information furnished above is true, complete, and correct to the best of my knowledge.*

I agree

I disagree

Consent*

By submitting this form, you consent to the collection, use, and processing of your personal information as outlined in our Privacy Policy.

Please sign below:*

Kloeck Gush Properties^TM
info@kgpluxuryrealty.co.za

Boutique Real Estate Agency Specialising in Luxury Properties

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