Investor Application — Golomt Asset Management LLC

Personal Information

Surname *

Given Name *

Family Name

National Identification Number *

Residential Address *

Contact Information

Email Address *

Cell Phone *

Work Phone

Employment Details

Employment Status *

Employer Name

Position

Work Address

About Investment

Investment Experience *

Total Assets (including securities, deposits, real estate, etc.) *

Are you a Politically Exposed Person?

Yes No

Emergency Contact Information

Relation to You *

Surname *

Given Name *

Cell Phone *

Are you a US citizen or US Green cardholder? *

Yes No

Note — FATCA (Foreign Account Tax Compliance Act)

US FATCA requires the Bank to properly identify all US persons including US Green cardholders. If you answered "Yes" or if you selected source of income as US Source, please fill in and provide the Golomt bank FATCA form and the W-8 or W-9 form issued from United States Internal Revenue Service (IRS).

↓ Golomt Bank FATCA Form PDF ↓ W-8 Form PDF ↓ W-9 Form PDF

General Information

Company's Name *

Legal Entity Type *

Company Registration No *

Tax Identification Number *

Date of Incorporation *

Country of Incorporation *

Registered Address *

Address of Main Business Activity *

Duration of Operation at Above Address (Years)

Contact Information

Phone Number *

Email Address *

Website

Business Details

Category of Legal Entity *

Nature of Business Activity *

Source of Funds *

Approximate Total Assets *

Details of Management Personnel

Management Person 1

Last Name *

First Name *

ID / Passport No *

Date of Birth *

Nationality

Phone

Home Address

Position

Politically Exposed Person

To add a Management Person, please click 'Add Person'.

Details of Contact Person

Contact Person 1

Name *

Position / Relation *

Phone *

Do you currently reside in Mongolia?

Are you or any member of the Management Personnel a US citizen or US Green cardholder? *

Yes No

Note — FATCA (Foreign Account Tax Compliance Act)

↓ Golomt Bank FATCA Form PDF ↓ W-8 Form PDF ↓ W-9 Form PDF