Investor Information Form – ICS Capital Berhad

Investor Information Form

Full Name: (as per in IC/Passport/Company)

NRIC No. / Passport No. / Company Reg. No:

Nationality

Date Of birth (D.O.B):

Gender

Contact Number

Email address

Residential Address:

Nominee

Relationship

Allocation

Nominee

Relationship

Allocation

Nominee

Relationship

Allocation

Occupation

Name of Employer

Source of Funds

Investment Amount

Investor Type

Proof of Payment

Bank Name

Bank Account No:

Account Holder Name:

SWIFT Code:

Scanned Copy of NRIC/Passport/Company Cert

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