Customer Setup KYC Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. of o Annual Razón social / Corporate name *RUC *Fecha de constitucion / Founding dateDomicilio social de la empresa / Place of business *Address Line 1Address Line 2CityState / Province / RegionPostal CodePaísAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryTeléfono / PhoneCorreo electrónico / E-mail *Transacciones estimadas anuales únicamente con Barrdega en USD / Annual transacions only with Barrdega USDCantidad estimada de transacciones bancarias únicamente con Barrdega / Annual estimated banking transactions only with BarrdegaPais de origen de las transferencias bancarias con Barrdega únicamente / Country of origin of banking transactions only with BarrdegaOrigen de los fondos / Source of fundsPrincipal línea de negocio / Main line of business¿Retención de ITBMS? Sales Tax Retention?050100III.Representante legal de la empresa/ Business Legal representantiveNombre / Name *FirstMiddleLastCédula de identidad / ID / Pasaport Pasaporte o cédula Drag & Drop Files, Choose Files to Upload, or Capture With Your Camera Camera Preview Sube una foto de la cédula o el pasaporte.País / CountryUnited StatesCanadaMexicoBrazilArgentinaColombiaChilePeruVenezuelaEcuadorGuatemalaCubaBoliviaHondurasParaguayEl SalvadorNicaraguaCosta RicaPuerto RicoPanamaUruguayJamaicaTrinidad and TobagoDominican RepublicHaitiBahamasBarbadosSaint LuciaGrenadaSaint Vincent and the GrenadinesAntigua and BarbudaSaint Kitts and NevisDominicaBelizeGuyanaSurinameFrench GuianaOtro / OtherOcupación / OcupationCorreo electrónico / E-mail *Teléfono / Phone *Persona Políticamente Expuesta (Reprentante (s) legal (es) o accionista (s)) / Political Exposed Person (PEP) (Legal representative (s) or shareholder (s))¿Cumple, ha cumplido o es cónyuge de una persona con funciones públicas o políticas destacadas, ya sea en el territorio nacional o en el extranjero? / Do you hold, have held or are spouse of a person that held a government position, either within the country, domestically or abroad? *--- Select Choice ---Si / YesNoSi su respuesta es afirmativa complete la siguiente información / If you answered “Yes”, please complete the following information.Nombre completo del PEP / PEP´s full nameCargo / PositionPaís / CountryUnited StatesCanadaMexicoBrazilArgentinaColombiaChilePeruVenezuelaEcuadorGuatemalaCubaBoliviaHondurasParaguayEl SalvadorNicaraguaCosta RicaPuerto RicoPanamaUruguayJamaicaTrinidad and TobagoBahamasDominican RepublicHaitiSaint LuciaBarbadosGrenadaSaint Vincent and the GrenadinesAntigua and BarbudaSaint Kitts and NevisDominicaBelizeGuyanaSurinameFrench GuianaDesde / From Hasta / Until Relación (si usted no es la PEP) / Relashionship (if you are not the PEP)Nota / Note: Nota: Los PEPs son quienes ocuparon estos cargos: diputados, presidente, vicepresidente, ministros y funcionarios nombrados con ese rango, viceministros, magistrados, contralor y subcontralor general de la República, superintendentes e intendentes, Contador Nacional, Tesorero Nacional, oficiales mayores de ministerios, presidentes ejecutivos, regidores, alcaldes y vicealcaldes, jefes de misiones diplomáticas, y extranjeros que ocupen o hayan ocupado puestos homólogos a los indicados. Note: PEP´s are those who, occupied the following positions: legislators, president and vice president, ministers, appointed officers with this rank, viceministers, magistrate judges, rectors and vice rectors, Comptroller General of the Republic, superintendents and intendants, National Accountant, National Treasurer, senior offices in the ministries, executive presidents, councilmembers, municipal mayors and deputy mayors, and heads of diplomatic missions. Also considered politically exposed persons are those foreigners who occupy or have occupied similar positions to those specified herein.Cumplimiento En cumplimiento con la legislación vigente, declaro que este formulario ha sido completado por mi o en mi presencia y que la información provista en el mismo es fiel y verdadera, por lo tanto acepto que cualquier omisión o falsedad en la información contenida en este documento causaría la cancelación de esta solicitud. Así mismo eximo en este acto de toda responsabilidad a la Barrdega; sus representantes y personeros por cualquier información falsa u omisa que en este formulario se haya consignado. In compliance whit current legislation, I declare that this form has been completed by me or in my presence and that the information provided herein is true and correct, therefore I agree and accept that any omission or misrepresenta'on on the informa'on contained in this document would lead to the cancella'on of this applica'on . Like wise, I release Barrdega from any lianility, its representa'ves and spokesmen for any false or missing information that has or hasn´t been declared in this form.Firma del Titular / Holder's Signature Clear Signature Fecha / DateEn todos los casos el formulario deberá estar acompañado del documento de identidad válido, vigente y legible del representante legal. Ademas de la Personería Jurídica de la compañia que contenga: Nombre, número ID, fecha de fundacion. In all cases, the form must be accompained by a valid ID / Pasaport / Dimex / DIDI, current and legible. Furthermore a legal company doc with: Name, ID number, founding date.Submit