CLIENT CONTACT DETAIL SHEET – Holland Condon forms

Sep 24, 2013

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

More fromLegal News