This document contains a 12-page submission package from an investor to a company regarding a private transaction. It includes a cover letter, letter of intent, client information sheet, identification documents, attestations, proof of funds documentation, history of funds, exclusive right to contract, corporate resolution if applicable, and authorization to verify funds. The investor is providing all required documentation and agreeing to terms in order to have their funds considered for investment purposes.
1. INVESTOR’S LETTERHEAD
(Company name – address – phone – fax - email)
INITIAL CLIENT INFORMATION SUMMARY
Date: ___________________
From: Client/Investor
To: U.S. Veterans Lifeline Aust Pty. Ltd.
Re:
Sir,
We/I are/am sending this submission package to you as we/I would like to engage in a private
transaction for the following as described below. We/I understand that we/I must submit a complete
package before our/my request will be processed. We/I agree to follow the procedures outlined
below and understand that changes to the procedures and the documents attached herein are not
allowed and will result to an immediate disqualification. This submission package includes the
following attachments and all of it is complete.
1. Letter of Intent (LOI)
2. Client Information Sheet
3. Passport copy in color / Certificate of incorporation
4. Attestation, NC/ND, Non Solicitation, Signatory Control
5. Proof of Funds/assets
6. History of Funds/assets
7. Exclusive Right to Contract
8. Corporate Resolution (if corporate)
9. Authorization to Verify and Authenticate Funds/assets
We/I will provide any additional information if requested.
We/I are/am submitting this submission package under penalty of perjury and agree that we/I have
submitted this package under our/my own free will and without any solicitation of any kind.
Thank you,
____________________
(Signature)
Name, Title
Passport No. / Country
Page 1 of 12
Initials
INVESTOR
2. INVESTOR’S LETTERHEAD
(Company name – address – phone – fax - email)
Attachment 1
LETTER OF INTENT
Date: _________________
From: Client/Investor
To: U.S. Veterans Lifeline Aust Pty. Ltd.
Re:
With full authority and responsibility, we/I are/am submitting this letter of our/my intent to
enter into an Agreement with U.S. Veterans Lifeline Aust Pty. Ltd. to generate moderate to higher
returns, utilizing private banking expertise.
We/I understand that only upon an invitation and approval will additional information and
related agreements be forwarded. A copy of our/my most recent tear sheet/bank statement from
the <Name of Bank/Brokerage Firm> confirming availability of funds/assets is enclosed
herewith. These funds/assets are of good, clean, non-criminal origin, free of liens, encumbrances
and available immediately for transfer, if necessary.
It is understood and agreed this letter is non-binding and that participation is by "invitation
only". We/I also affirm that this Letter of Intent is not the result of any solicitation of any form
from your behalf and we/I solemnly and sincerely swear that we/I will maintain the confidentiality
of all matters pertaining to all information disclosed to principals, partners, and clients that we/I
may become aware of, regardless of whether the information was available through the
performance of our/my business or occasionally and/or inadvertently obtained. If approved for
entry, please, forward any agreements and instructions.
We/I would like to provide U.S. Veterans Lifeline Aust Pty. Ltd. with <state amount
in cash for investment purposes>.
Yours truly,
__________________________
(Signature)
Name / Title
Passport No. / Country
Page 2 of 12
Initials
INVESTOR
3. INVESTOR’S LETTERHEAD
(Company name – address – phone – fax - email)
Attachment 2
CLIENT INFORMATION SHEET
In accordance with the Patriot Act of October 26, 2001, and amendments thereto; Articles 2 and 5
of the Due Diligence and Federal Banking Commission Circular of December 1998 and its
amended articles, concerning the prevention of money laundering, and Article 305 of the Swiss
Criminal Code, the following information may be supplied to banks and to financial institutions for
purposes of verification and identification regarding these matters.
All parties are obligated to respect professional secrecy and take all appropriate precautions to
protect the confidentiality of the information it holds in respect of their activities per the NC/ND
agreement. This legal obligation shall remain in effect at all times.
The below information is needed for each Signatory Control
Date of Information: _____________
A. For Individuals
a. Client Name:
b. Nationality:
c. Passport
i. Number:
ii. Date of Issue:
iii. Expiration Date:
iv. Issued by:
d. Date and Place of Birth:
e. Home Address
i. Street:
ii. City:
iii. State:
iv. Postal Code:
v. Home Telephone No.:
vi. Mobile No.:
vii. Home Fax No.:
viii. Email (copy 1):
ix. Email (copy 2):
B. For Companies
General information
f. Company Name: Client/Investor
g. Registration Office:
Page 3 of 12
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INVESTOR
4. INVESTOR’S LETTERHEAD
(Company name – address – phone – fax - email)
h. Registered Address:
i. Street:
ii. City:
iii. State:
iv. Postal Code:
i. Business Telephone No.:
j. Business Fax No.:
k. Business Email :
l. Register of members or list of shareholders holding a controlling interest
m. Identification as described above for individuals who are beneficial owners of
corporate shareholders holding 10% or more of the share capital.
Legal Advisor/Mandate (if none please state):
n. Name:
o. Company Name:
p. Company Address
i. Street:
ii. City:
iii. State:
iv. Postal Code:
q. Company Phone No.:
r. Company Fax No.:
s. Email:
C. Certification
a. Applicant hereby declares that the undersigned is the Authorized Signatory or owner of
the Funds/assets, or the duly appointed representative with full Signatory power on the
bank account to transfer, assign, pledge or reserve the cash upon terms satisfactory to
Applicant, further that vested with fully authority to execute all documents and
agreements relating to the same. (Please provide Corporate Resolution in Attachment 8
signed and sealed.)
b. Applicant hereby grants permission to contact all parties and institutions named within
this document including the Authorization to Verify Funds/assets (Attachment 9) at
Applicant’s Bank.
We/I hereby swear, under penalty of perjury, the information given hereon is accurate and
true.
_____________________
(Signature)
Name, Title
Passport No. / Country
Page 4 of 12
Initials
INVESTOR
5. INVESTOR’S LETTERHEAD
(Company name – address – phone – fax - email)
Attachment 3
IDENTIFICATION
A. For Individual
i. Please provide a COLOR copy of Passport of the Owner of the Funds/assets / Authorized
Signatory. Please enlarge (140%)
ii. Please provide a current Certificate of Good Standing from your bank.
B. For Companies
i. Please provide a certificate of incorporation and any change of name certificate.
ii. Please provide a current Certificate of Good Standing from the State/Country where
the Corporation/Business Entity was Incorporated/Formed
Page 5 of 12
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INVESTOR
6. INVESTOR’S LETTERHEAD
(Company name – address – phone – fax - email)
Attachment 4
ATTESTATION – NON CIRCUMVENTION – NON DISCLOSURE – NON SOLICITATION
SIGNATORY CONTROL
Date: ________________
From: Client/Investor
To: U.S. Veterans Lifeline Aust Pty. Ltd.
Re:
NON SOLICITATION AND REQUEST FOR INFORMATION
I, <client name> as Authorized Signatory and/or Owner of the Funds/assets, do hereby affirm that I
have requested specific confidential information and documentation from your organization
regarding private placement investment programs for my interest and purposes. I solemnly and
sincerely swear that I will maintain the confidentiality of all matters pertaining to any/all
individuals, principals, employees, partners, and clients that I may become aware of, regardless of
whether the information was available through the performance of my business or occasionally
and/or inadvertently obtained.
I hereby declare that I am fully aware that the information received or to be received from you is in
direct response to my request and it is not considered or intended to be a solicitation or offering of
any kind. It is intended solely for my general knowledge. I further attest that I requested this
information of my own free will and accord.
I affirm that the Funds/assets on deposit to be placed with the program for the purposes herein
referenced will be done so at our specific request and authorization.
It is agreed that a facsimile copy of this letter, or any associated documents to this transaction, are to
be considered as valid and as legally acceptable as the original.
Signed this ______________day of ____________, 2015.
_____________________
(Signature)
Name, Title
Passport No. / Country
Page 6 of 12
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INVESTOR
7. INVESTOR’S LETTERHEAD
(Company name – address – phone – fax - email)
Attachment 5
PROOF OF FUNDS/ASSETS
Documents required:
i. Fresh tear sheet or
ii. Up-to-date Bank Statement or
iii. Official letter from the bank where the Funds/assets are lodged, signed by two (2)
Bank Officers
All documents should be dated within 5 business days.
Page 7 of 12
Initials
INVESTOR
8. INVESTOR’S LETTERHEAD
(Company name – address – phone – fax - email)
Attachment 6
HISTORY OF FUNDS/ASSETS
Date: _____________________
From: Client/Investor
To: U.S. Veterans Lifeline Aust Pty. Ltd.
Re:
Principal Funds/assets Information
a. Amount of Funds/assets:
b. Currency:
c. Date Funds/assets were transferred into Account:
d. Bank where Funds/assets are on deposit:
e. Bank Address:
f. Bank Officer Name:
g. Account Name:
h. Account Number:
i. Bank SWIFT/ABA No.:
j. Account Signatory:
k. Are Funds/assets free and clear without liens:
l. If Funds/assets have not been in the above account for three (3) years or more please list
previous accounts
i. Amount of Funds/assets:
ii. Currency (3 digit ID):
iii. Date Funds/assets were transferred into Account:
iv. Bank Name where Funds/assets were:
v. Bank Address:
vi. Bank Officer Name:
vii. Account Name:
viii. Account Number:
ix. Bank SWIFT/ABA No.:
x. Account Signatory:
Sir,
We/I <Company/client name>, under penalty of perjury make the following statements
about the above referenced account for a contemplated private banking transaction.
1. How, when and by whom the Funds/assets/Asset were generated?
Page 8 of 12
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INVESTOR
9. INVESTOR’S LETTERHEAD
(Company name – address – phone – fax - email)
2. If Funds/assets/Asset has been assigned, why, when and to whom?
3. Who is the current owner of the Funds/assets/Asset?
4. Brief description of the company’s activity(ies) / actual profession (for individual)
5. Length of time that the Funds/assets/Asset have been in the current account (If less than
three (3) years please state previous accounts)?
6. Who is the Signatory on the account?
Certification
a. Funds/assets are legally earned, taxed, and include no independent third party managed
funds/assets.
b. All information supplied in the submitted documentation and the funds/assets involved
are not in violation of the Patriot Act of October 26 2001, and amendments thereto, with
its related financial crimes counterparts, however interpreted, defined and enacted,
whether within the United States or internationally.
c. Subject funds/assets have no liens, commercial obligations or encumbrances of any kind.
d. Fund owner is not a party to a law suit or pending adverse legal action, further, there are
no pending contracts existing, or about to exist, that could affect said cash assets.
We/I <Company/client name>, the undersigned hereby swear under penalty of perjury that
the information given is accurate and true, and, that we are not associated with any charitable
cause or organization that supports terrorist activities and, we are not part of, or a front for
any Money laundering Scheme or any illegal drug traffic or money laundering activities. The
funds/assets are in compliance with the Financial Action Task Force (FAFT) of June 2001,
and the USA Patriot Act, and are not from terrorist sources. All our business activities are
totally legal. I confirm under penalty of perjury that all information is true and that all of the
beneficial owners of the entry capital have been disclosed.
For and on behalf of
____________________
(Signature)
Name, Title:
Passport No. / Country:
Page 9 of 12
Initials
INVESTOR
10. INVESTOR’S LETTERHEAD
(Company name – address – phone – fax - email)
Attachment 7
EXCLUSIVE RIGHT TO CONTRACT
Date: ___________________
From: Client/Investor
To: U.S. Veterans Lifeline Aust Pty. Ltd.
Re: PRIVATE PLACEMENT - EXCLUSIVE RIGHT TO CONTRACT
We Client/Investor, hereby swear under penalty of perjury that all other parties that have
received this information have received a Cease & Desist Order letter and that they will no longer
work to complete the transaction that has been brought forward to their principal.
We Client/Investor, hereby confirm that We/I have the Funds/assets currently available
under our/my control to block for this transaction and further, that they are not encumbered in any
way.
(Signature)
Name, Title
Passport No. / Country
Page 10 of 12
Initials
INVESTOR
11. INVESTOR’S LETTERHEAD
(Company name – address – phone – fax - email)
Attachment 8
CORPORATE RESOLUTION
Reference: A. Minutes of the Directors meeting held on <date>
B. Articles of Incorporation of the Corporation
Meeting of the Board of Directors of <Client/Investor> held in accordance with the Articles of
Incorporation.
Present at the meeting were the following Directors: <name of directors>
Present at the meeting was the Secretary of the Board: <name of secretary>
Meeting of Directors undertook the following Corporate Resolution which has been recorded as
"Reference A" in the Minutes of the Corporation Meeting Book.
To utilize Funds/assets on Deposit in the amount of <amount in words> EURO (€<amount in
numbers>) drawn on <name of bank> located at <address of bank> for investment purposes.
Additionally, the duly appointed Authorized Signatory, Mr Gerald Mathew Egan holder of
Australian passport number L.6468977 as trustee of the Funds/assets, is authorized to open and
operate Corporate bank accounts, enter into project funding and/or fee agreements to receive and
distribute all profits from the placement, enter into agreements as necessary, and to make selections
as to which Shares Subscription or investments will best suit the placement of these
Funds/assets/Assets so as to assure financial returns.
It is therefore resolved that the appointed officer shall have the authority to negotiate all
details and sign the final contract with the Portfolio, the Funds/assets Manager and Bank
Officers. There being no further business, the meeting was declared closed, and in witness
thereof, the directors signed below on the date first written above.
____________________
(Signature)
Name / Title:
Passport No. / Country
___________________ CORPORATE SEAL + NOTARISED
(Signature)
Name / Title:
Passport No. / Country
Page 11 of 12
Initials
INVESTOR
12. INVESTOR’S LETTERHEAD
(Company name – address – phone – fax - email)
Attachment 9
AUTHORIZATION TO VERIFY & AUTHENTICATE FUNDS/ASSETS/ASSETS
NOTE: OWNER OF THE FUNDS/ASSETS MUST ALSO SEND A COPY OF THIS LETTER
TO HIS/HER BANK OFFICER TO ALLOW FOR BANK-TO-BANK COMMUNICATION.
Date: __________________
From: Client/Investor
To: U.S. Veterans Lifeline Aust Pty. Ltd.
Re:
INVESTOR’S REFERENCE CODE: …... M USD/ …… (client’s name)
I, ……………(client’s name), AM THE OWNER OF THE FUNDS/ASSETS DESCRIBED AS
….. MILLION EUROS (€….,000,000.00 EURO), HOLDING PASSPORT NO. …….., ISSUED
BY …………….., DO HEREBY AUTHORIZE YOUR BANK OR BANK OFFICER OR
FUNDS/ASSETS MANAGER, TO OBTAIN VERIFICATION OF OUR CLEARED AND OF
NON-CRIMINAL ORIGIN FUNDS/ASSETS/ASSETS CURRENTLY HELD ON DEPOSIT AT
………………..(Bank name) ON A BANK TO BANK BASIS, UPON PROVIDING ME WITH
DUE AND TIMELY NOTICE OF THE COORDINATES OF THE INQUIRING PARTY(IES).
BANK NAME:
BANK ADDRESS:
BANK OFFICER:
POSITION:
TELEPHONE:
NAME OF ACCOUNT:
ACCOUNT/SKR NUMBER:
SIGNATORY OF ACCOUNT:
BANK SECURITY CODE:
_____________________________
……….(client’s name) / Owner
Passport No: …………./ Country: ………….
Notary Seal
Page 12 of 12
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INVESTOR