ALPHA SALES ADVISORS ONBOARDING FORM
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Referral Code:
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Agency Manager Username:
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* Compulsory fields
General Information
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Name/Company Name:
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Street Address:
Mailing Address:
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Telephone Number:
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Fax Number:
Website Address:
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Date of Establishment:
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Place of Establishment:
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Principal Contact Name:
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Principal Contact Telephone Number:
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Email of Principal Contact:
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Bank Name:
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Account Number:
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Account Name:
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Legal Status of Company
(Partnership, LLC, Plc, Venture, Enterprise etc.)
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Interim & Ultimate Parent Company(ies):
If more than one, separate each with a semicolon(;)
Management & Ownership
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Is the Company private or Publicly held? :
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Select an Option
Private
Public
Owner(s):
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If more than one, separate each with a semicolon(;)
Nationality:
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Percentage Ownership (%):
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Chairman/President:
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MD/CFO/DMD/Executive Management:
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Other Details
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Previous company name/names used within the last 5 years:
If more than one, separate each with a semicolon(;)
Professional organisations to which the Company belongs:
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If more than one, separate each with a semicolon(;)
Is any owner, officer, director, employee, representative or retained consultant of the Company or one of its affiliates a government official, political party official, or candidate for political office?:
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Select an option
Yes
No
If "Yes" to previous question, list names, titles and governmental positions:
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Does any owner, officer, director, employee, representative or retained consultant of the Company or one of its affiliates have any personal or professional affiliations with any government officials, political party officials or candidates for political office?:
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Select an option
Yes
No
If "Yes" to previous question, list names, titles and governmental positions:
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Previous relationship with AXA Mansard
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Has the Company or any of its affiliates, been the subject of past or pending legal, arbitral, or regulatory proceedings in the country where the Company is domiciled or where it is to provide Services under the proposed arrangement?
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Select an option
Yes
No
If "Yes" to previous question, Kindly give a description:
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Has the Company, any of its affiliates, or any of its owners, officers, directors or employees ever been the subject of a criminal investigation, indictment, or a similar proceeding in the country in which the proposed current arrangement is to occur? Ever been convicted in any criminal matter?:
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Select an option
Yes
No
If "Yes" to previous question, Kindly give a description:
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Does the Company have a Code of Conduct , Anti-Bribery Policy or a similar Compliance Policy?:
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Select an option
Yes
No
Documents
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Certificate of Incorporation:
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Certified True Copy of Particulars of Directors:
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Memorandum and Articles of Association :
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Code of Conduct, Anti-Bribery Policy or a similar Compliance Policy:
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