Statement of Wealth

Customer Name*
Customer Account Number*
Accounts Maintained at Other Banks:*
Bank Name Account Number Account Type (Current, Savings, Certificates of Deposits etc.) Account Currency Credit Balance (Amount)
Shares and Securities Held:*
Company's Name Type (Shares/Securities) Number Purchase Price Current Market Value
Other Sources of Income:*
Salary Pension Inheritance Others
Customer E-Signature
Property Details*
Type Address Final Sale Contract Initial Contract Registration Number Contractual Value Current Market Value Seller Buyer
Name*
Date*
DD slash MM slash YYYY
Consent*
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86588

Bank Name	Account Number	Account Type (Current, Savings, Certificates of Deposits etc.)	Account Currency	Credit Balance (Amount)

Company's Name	Type (Shares/Securities)	Number	Purchase Price	Current Market Value

Salary	Pension	Inheritance	Others

Type	Address	Final Sale Contract	Initial Contract	Registration Number	Contractual Value	Current Market Value	Seller	Buyer