New Client Application Form

Step 1 of 10 - Primary Investor Information

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Primary Investor Information

Full Legal Name*

First

Date of Birth*

MM slash DD slash YYYY

Nationality*

Country of Residence*

Residential Address*

Email Address*

Mobile / Contact Number*

Account Type

Select the type of account you are applying for*

Single Account

Joint Account

Corporate Account

Joint Account Holder (If Applicable)

If Joint Account is selected, please provide full details for the second account holder.

Full Legal Name

First

Date of Birth

MM slash DD slash YYYY

Nationality

Country of Residence

Residential Address

Email Address

Mobile / Contact Number

4. Corporate Account Information (If Applicable)

Only complete if applying as a company or institution.

Company Name

Business Registration Number

Registered Business Address

Authorised Signatory Name(s)

Investment Details

Investment Amount (in EUR €)*

Preferred Investment Term*

1 Year

2 Years

3 Years

4 Years

5 Years

Over 5 Years

Income Distribution Preference

Monthly Income

Paid at Maturity

Occupation & Source of Funds

Occupational Status*

Employed

Self-Employed

Retired

Unemployed

Employer or Business Name

Tax & Compliance

Country of Tax Residence

Tax Identification Number (Optional)

Are you a Politically Exposed Person (PEP)?

Yes (We may request additional documentation)

Document Uploads

Please upload the following:

Proof of Identity*

Max. file size: 1 GB.

(e.g. Passport, National ID, or Driver’s Licence) [Upload Field]

Proof of Address*

Max. file size: 1 GB.

(e.g. Bank Statement or Utility Bill dated within the last 90 days) [Upload Field]

Joint and Corporate accounts must upload documentation for all listed individuals or authorised persons.

How Did You Hear About Us?

How Did You Hear About Us?*

Telephone Call from a Doherty Bergin Consultant

Referred by a Financial Adviser

Online Inquiry

Referred by a Current Client

Other

Declarations

Please tick to confirm*

I am a resident of the European Economic Area (EEA)

The information I’ve provided is accurate and complete

I understand that all investments are held in Euro (€)

I acknowledge that qualifying funds are protected by the Deposit Guarantee Scheme (Directive 2014/49/EU): – €100,000 per individual

I have read and accept the [Terms & Conditions] and [Privacy Policy]

I consent to being contacted by a member of the compliance team

Become a Client of Doherty Bergin Financial Services