"*" indicates required fields Unique IDSource of Funds / Wealth FormSection A - Policy Owners DetailsThe information requested is necessary to comply with the provisions of the Criminal Justice (Money Laundering and Terrorist Financing) Act 2010 Name* First Last Occupation* Staff Number:* Address* Street Address Address Line 2 City County Postal Code Section B - Source of FundsThis section must be completed if paying by Bank Draft / Postal Order or if payment is not a cheque or Direct Debit drawn on the account of the Policy Owner Payment to be made by?* Direct Debit Personal Cheque Bank Draft Postal Order EFT HiddenBank DetailsAccount Holder's Name* Name of Bank / Building Society* IBAN* BIC* Country Account is Based* Section D - Declaration by the Policy OwnerPolicy Holder's Signature*I declare that the statements provided in this form are true and complete:Section E - Supported DocumentsPhoto of Identification*Identification accepted - Driving Licence / PassportAccepted file types: jpg, jpeg, png, bmp, Max. file size: 2 MB.Proof of Address*Photo of Bill with Account Holder's Name and Address visibleAccepted file types: jpg, jpeg, png, bmp, Max. file size: 2 MB.HiddenCompleted Application Form HiddenChecksum