Private Placement Program: Client Compliance Application
Private Placement Program: Client Compliance Application
Established 2008
Disclaimer
The information in this document is intended solely for the benefit of firms and individuals seeking to be connected with financial information including, Funding and Monetization sources, PPP (Private Placement Programs) and Financial instruments.
Material provided by Secure Platform Funding may list possible service features and / or sample institutions for informational purposes only. None are guaranteed and all are subject to change on a daily basis. Nothing in this document constitutes an
offer or solicitation to purchase any investment, solution or a recommendation to buy or sell securities nor is it to be construed as investment advice. The services provided by Secure Platform Funding may not be available in all jurisdictions or to all
persons/entities. We select our clients carefully and do not accept all applications. Due to FATCA (Foreign Account Tax Compliance Act) we DO NOT provide ANY services to US Passport Holders, US Companies, clients utilizing Banks located in
the US for transactions, or Clients that Reside in the US, or Businesses with Head Offices located in the US. You acknowledge that Secure Platform Funding has advised you that all transactions have risk, and that prior to entering any transaction all
clients should undertake to consult Independent Legal and Accounting Experts prior to commencing, signing or committing to any transaction. Our Business is neither a Mutual Fund, Bank, Broker, Finance Company, Financial Adviser or Licensed in
any way. We hereby advise all clients that any contemplated transaction(s) of our Clients are strictly private and in no way relate nor does not involve the sale of registered public securities. All transaction information is strictly private, confidential and
classified and not to be provided to parties not approved in writing by Secure Platform Funding nor published or referred to in any public forum on the internet or in the media. Disclosure, copying, distribution, reprinting or reuse of the contents or
information in the form or on our web site is completely and totally prohibited.
Disclaimer: This document is provided in Microsoft Word Format for ease of the client’s completion. Under no
circumstances are the clauses or contents in this document to be removed or deleted. Any client who is found to have
removed or deleted clauses in this document will immediately have their transaction cancelled and will be deemed to have
committed fraud with appropriate penalties being imposed on them.
_____________________________________________City____________________ State___________
Country:____________________________________________________________________________
hereby confirm the following:
A. Program Confirmation
I would like to apply for enrolment and acceptance into the Private Placement Program and confirm I
have the following amount of cash funds available to be placed in the Private Placement Program:
B. Eligibility Declaration
I confirm that neither I or any person or company I represent is in ANY of the following categories that
Secure Platform Funding will NOT provide service to:
Due to FATCA (Foreign Account Tax Compliance Act) we DO NOT provide ANY services to:
We DO NOT provide ANY services to Passport holders or Businesses from the following countries:
Afghanistan
Libya
North Korea
Sudan
Syria
Yemen
Date Signed:______/______/______
In accordance with Articles 2 through 5 of the Due Diligence Convention and the Federal Banking Commission
Circular of December 1998, and under the US Patriot Act of 2002, as amended in February 2003 concerning the
prevention of money laundering and 305 of the Swiss Criminal Code and Anti Money Laundering Act, the
following information may be supplied to banks and/or other financial institutions for purposes of verification of
identity and activities of the Client described below, and the nature and origin of the funds which are to be
utilized. The foregoing is subject to agreement by all parties to whom this information is provided that they are
obligated to respect the privacy rights of the Client and all individuals described herein, as well as the generally
accepted professional standards relating to the maintenance of confidential information, and to take all appropriate
precautions to protect the confidentiality of the information contained herein, This legal obligation shall remain in
full force indefinitely without restriction.
Corporate
First Name :
Last Name :
Date and Place of Birth :
Nationality :
Passport Number :
Date of Issue of the Passport :
Expiry Date of the Passport :
Title in the Corporation :
Mobile Phone Number :
Home Address :
Home Telephone Number :
Home Facsimile Number :
E-mail Address :
Details of the Bank Account – Where your Deposit Funds are held
Bank Name :
Bank Address :
Bank Swift Code :
Account Name :
Account Number :
Account Signatory Name and Title :
Bank Officer Name and Title :
Bank Officer Telephone Number :
Bank Officer Facsimile Number :
Bank Officer E-mail Address :
I, (INSERT YOUR NAME) warrant and attest, with full personal and corporate responsibility that as the
beneficial owner; I have full legal title and authority with no governing restrictions over the herein described
collateral, cash and/or assets and also acknowledged as such by my depository financial institution.
We hereby grant the Transacting Principals and/or Secure Platform Funding full permission and authority to
verify, confirm, and reconfirm said collateral and/or assets on a bank-to-bank basis and conduct standard
background checks of the collateral and/or assets, and the corporate entity owning such.
I warrant and attest that I have not authorized or offered to any other party, consultant, broker or investor the
placement of the collateral and/or assets defined herein nor have I shopped the collateral and/or assets to any other
financial broker, consultant or company in the last 8 weeks.
I certify and attest that at no time has your organization or any agent and / or appointee on your behalf made any
offer or solicitation.
I, (INSERT YOUR NAME) attest and warrants with full responsibility under the penalty of perjury that:
a) The available Proof of Funds listed in this Application are from good, clean, cleared sources, free and
clear of security interests or similar interests of any kind or nature whatsoever.
b) I or the company I act for are the full owners of the Proof of Funds.
c) The Proof of Funds have been legitimately earned and obtained from non-criminal & non terrorist origins.
d) The Proof of Funds are free and clear of any liens or encumbrances and the Proof of Funds are under my
signatory control, immediately available and freely transferable without consent of any third party.
e) The Proof of Funds are legally earned, taxed, and include no independent third-party managed funds.
f) The Proof of Funds owner is not a party to a law suit or pending adverse legal action, further, there are no
pending contracts existing, or about to exist, that could affect the said funds.
g) All information supplied in the documentation submitted with this Application and the funds involved,
are not in violation of the Patriot Act of October 26, 2001, and amendments thereto, with its related
financial crimes counterparts however interpreted, defined and enacted, whether within the United States
or any other international jurisdiction.
I, (INSERT YOUR NAME), as Account Holder and duly Authorized Signatory, do hereby confirm that I have
requested of you and your organization, specific confidential information and documentation on behalf of myself
regarding currently available Private Financial Opportunities to serve only my interest, education, and not for
further distribution.
I hereby agree that all information received from you is in direct response to my request, and is not in any way
considered or intended to be a solicitation of any sort, or any type of offering, and for my general knowledge
only. I hereby affirm under penalty of perjury, that I have requested this information from you and your
organization of my choice and free will and further, and that you have not solicited me in any way.
I understand that any contemplated transaction is strictly one of a private nature, and is in no way relying upon, or
relating to, the United States Securities Act of 1933, as amended, or related regulations, and does not involve the
sale of public securities.
Further, I hereby declare that you have disclosed that you are not a licensed security trader, attorney, bank officer,
certified public accountant or financial planner. Any information, work or service conducted hereunder is that of a
private individual and that this is a project funding transaction that is exempt from the Securities Act and not
intended for the general public but Private Use only.
I acknowledge that submission of this application is no guarantee of acceptance, that no reason for being declined
needs to be given, nor do I have a right to appeal any decision. I agree that regardless of the outcome with my
application I will not to make any negative public or private statement either in writing or verbally to any other
party, website, media company or person.
The electronic or facsimile transmission of these documents shall be considered a binding and
enforceable instrument, treated as original copy. Original may be obtained upon request.
I, (INSERT YOUR NAME), hereby declare with full personal and corporate responsibility under penalty of
perjury that the information given within this application true and correct, genuine and accurate, that I have had
the opportunity to consult appropriate professional accounting and legal advice and that I have read and
voluntarily agree to all statements in this documentation without reservation or hesitation.
Signed____________________________________________ Date_____/_____/_____
______________________________________________________________________
The meeting of the Directors undertook the following Corporate Resolution, which has been recorded in the
Minute of the Book of the Corporation.
Additionally it was unanimously resolved, that Authorized Persons Name of the Corporation who is the
authorized signatory of the funds/assets on deposit, is authorized to use corporate bank accounts, to enter into
instrument, monetization, sale, trading and fee agreements as necessary, to make selections as to which
investment or private financial opportunity will best suit the placement of these funds/assets so as to assure the
anticipated financial returns and to receive and distribute all profits from the investment, monetization, sale,
trading or private financial opportunity.
The necessary authority and powers required to undertake these tasks and responsibilities are hereby granted to:
Name :__________________________________________________
Passport No. :__________________________________________________
Country of Origin :__________________________________________________
It is therefore, unanimously resolved that the appointed officer above shall have the authority to negotiate all
details and sign the final contract with the officer representing the investment, monetization, sale, trading or
private financial opportunity and associated authorities or bank officers.
There being no further business, the meeting was declared adjourned, and in witness thereof, the directors signed
below on the date first written above.
5. PASSPORT
I, (INSERT YOUR NAME), hereby declare with full personal and corporate responsibility under penalty of
perjury that the passport above is mine and is true and correct, genuine and accurate.
Signed____________________________________________ Date_____/_____/_____
Must be Good Clear Photo and NOT Santized with Information Obstructed or Hidden
I, (INSERT YOUR NAME), hereby declare with full personal and corporate responsibility under penalty of
perjury that the Proof of Funds balance above is true and correct, genuine and accurate as of the date I have
signed this declaration and that the funds above are under my direct control, earned freely and legally, are not
from any criminal activity or origin and are unencumbered and available to complete any transaction the
corporate resolution in this application requires.
Signed____________________________________________ Date_____/_____/_____
The undersigned are potentially and mutually desirous of doing business with respect to the arranging a financial transaction in cooperation
with one another and with potential third parties for the mutual benefit of all. It is their intention that the information exchanged among the
signatories in the course of doing business, as well as the documents which will be generated subsequent to the execution of this
Agreement, including but not limited to Buyers, Financers and Sellers identity, their websites or any electronic information and data, letters
of intent, full corporate offers, bank comfort letters, contract terms and conditions, project plans and details, business and finance plans,
financial and banking details or pre-advised payment instruments, and/or any information contained in such documents, will not be passed,
under any circumstance, to another intermediary or broker or trader of any other company or private person who is not an end buyer or end
supplier, without prior specific written consent of the party or parties generating or without proprietary rights to such information and/or
documentation.
This Agreement shall obligate the undersigned parties and their partners, associates, employers, employees, affiliates, subsidiaries, parent
companies, nominees, representatives, successors, clients and assigns (hereinafter collectively referred to as ‘The Parties’) jointly,
severally, mutually and reciprocally for the term of and to the performance of the terms and conditions expressly stated and agreed to
below. Furthermore, whenever this Agreement shall be referenced in any subsequent document(s) or written agreements, the terms and
conditions of the Agreement shall apply as noted and shall further extend to any exchange of information, written, oral or in any other
form, involving financial data, personal or corporate names, contracts initiated by or involving the parties and any addition, renewal,
extension, rollover amendment, renegotiations or new agreement that are in any way a component of what shall hereinafter be referred to as
‘The Project’ or ‘The Transaction’.
NON DISPARAGEMENT
Party 1 agrees to act with Privacy and Confidentiality by protecting the personal and professional reputation of Party 2 by agreeing that,
neither it nor any of its Affiliates, employees, investors, family, friends or Associates will directly, indirectly or anonymously, in any
capacity or manner, make, express, transmit speak, write, verbalize or otherwise communicate in any way (or cause, further, assist, solicit,
encourage, support or participate in any of the foregoing) including web sites, media, or social media, any remark, comment, message,
information, declaration, communication or other statement of any kind, whether verbal, in writing, electronically transferred or otherwise,
that might reasonably be construed to be derogatory, disparaging, critical of, or negative toward Party 2 or any of its directors, officers,
affiliates, subsidiaries, employees, agents or representatives or any party associated with any transaction being facilitated by Party 2. In the
event Party 1 breaches this Non Disparagement Clause, Party 2 is immediately and automatically to be awarded liquidated damages of
$1,000,000 (One Million) USD for each proven public disparaging statement and $500,000 (Five Hundred Thousand Dollars) USD for
each proven private disparaging statement and Party 2 will have the full legal right to pursue any and all legal remedies against Party 1
including court action to enforce this clause and collect any liquidated damages amounts owed by Party 1. Nothing in this clause shall
prevent any person from testifying when subpoenaed or required by law by a Government Agency.
TERM
This Agreement shall be for ten years commencing from the date of this Agreement. This Agreement may be renewed for an additional ten
years, subject to and upon the terms and conditions mutually agreed between and among the signatories. The Parties agree not to make
contact with, solicit, deal with, or otherwise to be involved in any transaction(s) with regard to source, contact, trust, strategic partner
and/or any other entity that the other Party introduces to or discusses with the other Party for a period of 18 months after termination of this
Agreement. The term may be extended automatically if the project is not closed during that time. This Agreement shall apply to: All
transactions originated during the term of this Agreement; and all subsequent transactions that are follow up, repeat, or extended
transactions or renegotiation(s) of transactions originated during the terms of this Agreement. Each Transaction shall be registered by the
parties or their representatives and a record maintained of Date, Party, project and results and sent to all parties as it changes. This
agreement supersedes any prior agreement.
ARBITRATION
All disputes arising out of or in connection with this Agreement with the exception of the Non Disparagement Clause shall be fully and
finally resolved by arbitration in accordance with the appointment of one professional Arbitrator in the country of Nevis as decided by
Party 2. All such arbitration awards shall be binding on all Parties and enforceable by law. Party A in this agreement consents willingly to
waive all rights to engage in any legal action in any court in any jurisdiction and agrees that any and all disputes between the parties with
the exception of the Non Disparagement Clause will be resolved solely by way of Arbitration.
The Parties further agree to carry out the terms of any arbitration award without delay and shall be deemed to have waived their right to any
form of alternative recourse in court by or through any other means, in so far as such waiver can validly be made.
Each of Parties named in an Arbitration proceeding and/or required to appear under such a proceeding, unless otherwise agreed, shall be
responsible for its own legal expenses. The prior sentence notwithstanding, any Party adjudged by the Arbitrator to be in material breach of
this Agreement shall compensate in full the aggrieved party, it's heirs assignees and/or assigns, for the total remuneration received as a
result of business conducted with the Parties covered by this Agreement, plus, subject to the determination of the Arbitrator reasonable
arbitration costs, legal expenses, and other charges and damages incurred relative to its dealings with banks, lending institutions,
corporations, organizations, individuals, lenders, or borrowers, buyers or sellers that were introduced by the aggrieved party,
notwithstanding any other provisions of the awarded.
FORCE MAJEURE
NOTE: Initial, Date and Sign all pages in sequence including all parties representing the Party 1 and Party 2.
Party 1:
Company Name:___________________________________________________
Address: _________________________________________________________
Phone: ___________________________________________________________
Email: ___________________________________________________________
Signature_______________________________Signature Date_____/____/____
_________________________________________________________________
Party 2
Signature____________________________________
Management