SCOPE / OBJECTIVE

The ques onnaire will be asked to the User/Client that completed the KYC Veri ca on, whereby the
User will have to disclose their source of funds along with appropriate documenta on required.

S.No. Proof of Funds ques ons to be asked to our User / Client

1. EMPLOYMENT STATUS
1.1. Kindly state your employment status. *

☑ Employed ☑ Self-Employed/Entrepreneur ☑ Student ☑ Re red ☑

Unemployed

1.2. If Self - Employed/Entrepreneur, what is the Nature of your Business*

Please specify:
I am self-employed in a men's and women's clothing store.

1.3. If Employed, what is your Current Job Role?*

Please specify:
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 2. NET WORTH / FINANCIAL STATUS
2.1 What is your total es mated net worth?*

Less than USD 20,000 If Other, please specify:

my total net worth is 100,000 USD, which consists of two houses and a car
which generate this amount.

2.2. If Employed or Self Employed/Entrepreneur, what is your Total Annual Income?*

Please specify:

my total annual income is 15,000 USD

2.3. Kindly chose the Proof of Income from the below check box op on*

☑ Bank Statement for the Last 6 months ☑ Employer Pay Statement

☑ Tax Payment Form ☑ Crypto Wallet Statement ☑ Online Trading Wallet
Statement
☑ Other
If Other, please specify:

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 Please a ach the selected Proof of Income (Uploading Op on)

2.4. If Unemployed / Re red / Student, what is your Total Annual Income?*

Please specify:

2.5. Kindly chose the Proof of Income from the below check box op on*

☑ Bank Statement for the Last 6 months ☑ Tax Payment Form

☑ Crypto Wallet Statement ☑ Online Trading Wallet Statement
☑ Other
If Other, please specify _____________
Please a ach the selected Proof of Income (Kindly upload this le)

2.6 Any other Source of Fund you wish to declare.

☑ Sale of Property ☑ Inheritance of Wealth or Funds

☑ Other
If Other, please specify:

* Required to ll
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 Addi onal Ques ons on the basis of the withdrawal amount:-

● On the basis of the Total Annual Income and the type of Category the Users fall into they will
have to ll up the addi onal documents.
● The below informa on is what the Users will receive:-

For Broker Group Ltd to comply with the global AML (An Money Laundering) Regula ons and
Legisla ons, it is mandatory for the Applicants to provide us with the below details which will assist us in
understanding how you have acquired your funds or wealth.

S.No. Addi onal Proof of Funds Ques ons

1. If Employed / Self-Employed

1.1. In the descrip on box kindly provide the origin and source of your wealth.*

(Text Box)

The source of my income depends on my real estate, the house I currently live in,
another house I rent and my clothing store, which I have been in for over 20
years.

1.2. Do you receive any bonuses?*

☑ Yes ☑ No.
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 On the basis of the above selected op on please a ach the suppor ng document
⬇ (Uploading Op on)
● Self Employed/ Entrepreneurs - Copy of recent nancial statement / tax statement /
crypto statement.
● Employee - Copy of the Bonus Pay Slip in the company le er head and the company
stamp.
● For all - Bank statement displaying the most recent income earned.
1.3. Sale of any asset or property?*

☑ Yes ☑ No.

If yes, please provide the suppor ng document. (Kindly upload this le)

1.4. Ownership of any valuable property or asset (Shares, bonds, etc.)?*

☑ Yes ☑ No.

If yes, please provide the suppor ng document. (Kindly upload this le)

(Text Box)
I do have valuable assets which are my two houses.

1.5. If you have other source of income please specify:-*

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 (Text Box)

my other source of income is one of my houses that I rent.

1.6. Kindly provide a brief descrip on about the ac vity or services provided by your company.*

(Text Box)

The services provided by my store are customer service for men's and
women's clothing and footwear.

1.7. If your business is related to any one of the following business ac vi es, as per the AML
(An Money Laundering) Regula ons and Legisla on, we will require addi onal
documenta on.
1. Law Firm or Legal Consultancies
2. Accoun ng or Audi ng Firm
3. Dealers of precious stones and metals
4. Corporate Service Providers
5. Real Estate Dealers
6. Casino, gambling or be ng industry
7. Money Exchange House
Please provide the below addi onal company documenta on:-*
☑ Trade License of the Company ☑ Ar cle / Memorandum of Associa on
☑ Directory Register ☑ Bank Statement of the Company
☑ Ul mate Bene cial Owner Cer cate / Declara on
* Required to ll
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 S.No. Addi onal Proof of Funds Ques ons

1. If Unemployed / Re red / Student

1.1. In the descrip on box kindly provide the origin and source of your wealth. *

Text Box:

1.2. If Re red, do you receive a monthly pension or re rement income? *

☑ Yes ☑ No.

If yes, please provide the suppor ng document. (Kindly upload this le)
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1.3. If Unemployed/ Student, did you receive any inheritance money?*

☑ Yes ☑ No.

If yes, please provide the suppor ng document. (Kindly upload this le)

1.4. Sale of any asset or property?*

☑ Yes ☑ No.

If yes, please provide the suppor ng document. (Kindly upload this le)

1.5. Ownership of any valuable asset or property?*

☑ Yes ☑ No.

If yes, please provide the suppor ng document. (Kindly upload this le)

1.6. Have you made any prior investment(s) in company(ies)/ funds?*

☑ Yes ☑ No.

If yes, please provide the suppor ng document. (Kindly upload this le)

1.7. If you have other source of income please specify:-*

Text Box:
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 1.8. If your investment in a company(ies) is related to any one of the following business
ac vi es, as per the AML (An Money Laundering) Regula ons and Legisla on, we will
require addi onal documenta on.
8. Law Firm or Legal Consultancies
9. Accoun ng or Audi ng Firm
10. Dealers of precious stones and metals
11. Corporate Service Providers
12. Real Estate Dealers
13. Casino, gambling or be ng industry
14. Money Exchange House
Please provide the below addi onal company documenta on:-*
☑ Trade License of the Company ☑ Ar cle / Memorandum of Associa on
☑ Directory Register ☑ Bank Statement of the Company
☑ Ul mate Bene cial Owner Cer cate / Declara on
* Required to ll
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