CIP Form – Individuals – Obelisco Advisers

Client Information Profile - Individuals

Name

Current Physical Address

Address in the US (If you have one)

Date of Birth

Telephone number

Mother’s Maiden name

Country of birth

Social Security Number (If you have one)

Citizenship

Do you have a US Visa

Occupation

How long have you been in that line of business?

Employer’s name

Employer’s Address

Initial Deposit

Amount of money per month: Coming in

Going out

Total number of transactions per month: Coming in

Going out