Personal Application Form

Personal Application Form

Name *

First

Last

DOB *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Home Phone

Mobile *

Email *

How did you hear about us?

Currency Requirements

Purpose of transactions

Destination of funds *

Estimated number of annual transactions

Estimated annual amount required (£)

Typical value of payments (£)

Source of funds**

Source of wealth***

Declaration

Full Name *

Agree to Pelham Points Terms and Conditions. *

Agree

Read terms and Conditions

*country where funds will be sent to
**country the funds will be coming from
***this describes how you have acquired your wealth or income. eg. salary, savings, inheirtance

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