KYC - Credit Application/Identification and Verification Form (AML)

(All field marked * are mandatory.)

Please ensure that the Form ST-120 is duly filled and signed in order to complete this KYC Form.
This is required to be uploaded towards the end of the form. Download FORM ST-120 here.
Business Information
Please Select One* :  

Key Employees


Bank Information
Trade References

Upload ST-120 Form *

Download the ST-120 form here, and upload the scanned copy duly filled.

Have You or will you establish an AML program, in accordance to USA Patriot Act?

I hereby authorize the release of any information to Shivani Gems, Inc. from the above named references for the purpose of establishing a credit account. I confirm that the above details are true and correct. I confirm that I have provided/will provide all required documentation. I Undertake to provide any changes to the aforesaid details. I confirm that where applicable, I have disclosed all relevant information.

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