CLIENT CONTACT DETAIL SHEET
Have you used this firm before: Yes: _______ No: ______ please tick.
Please when returning this form; send us a copy of your drivers licence or passport proving your name AND 2 utility bills (with your name on them) proving your address. Bring the originals to our first meeting. This is a requirement under Money Laundering Legislation. This applies to you and anyone else who intends using our services on this matter.
Your name: ______________________________
PPS Number: ___________________
Your date of Birth :_________________________
Your e-mail (write very clearly):
______________________________________________________
*If another party is with you
Their name: ______________________________
PPS Number: ___________________
Their Date of Birth: _________________________
Their e-mail (write very clearly):
______________________________________________________
Address for correspondence:
______________________________________________________
______________________________________________________
______________________________________________________
Your mobile number: _____________________
Partners mobile number: _____________________
Home land line: _____________________
Office land line: _____________________
Your fax number: _____________________
Emergency contact number: _____________________
Name, address and phone number of any other
Adviser (including financial) in this matter:
___________________________________________
___________________________________________
___________________________________________
Name of your contact in adviser’s office:
___________________________________________
If you have more advisers, then please list their details separately.
I/We INSTRUCT you and RETAIN you to act in this matter. I/We irrevocably AUTHORISE you to give such undertakings as you deem necessary to progress my matter/file.
I/We AUTHORISE your firm, Holland Condon, to lodge any cheque (whether or not it’s in our/my name(s)) to your client account in your bank, to be used for our/my benefit and to be accounted to me/us at the conclusion of this matter.
Signed by 1st person named above:
___________________________________
Signed by 2nd person named above:
___________________________________
Today’s date:
___________________________________
LTR/LTR55;13.a
