Customer Due Diligence

Personal Information

Name *

First

Last

Social Security Number (or comparable) *

Phone number *

Email *

Netfang

Staðfesta netfang

What is your nationality? *

Legal address information *

Heimilisfang

Borg

Ríki / sýsla / svæði

Póstnúmer

Land

Proof of identity *

Smelltu hér eða dragðu skjöl hingað til að senda þau inn. Þú getur sent inn allt að 4 skjöl.

Please take a photo of legal identity document, such as a your driver's license or passport.

Do you have a tax domicile in Iceland? *

Yes
No

Where is your tax domicile? *

Other: Where? *

Tax Identification Number (TIN) *

Don't know your TIN? Usually it's the same as your Social Security Number. You can find information here: https://www.oecd.org/tax/automatic-exchange/crs-implementation-and-assistance/tax-identification-numbers/

Do you get any income from the USA, e.g. salary, interest payments and/or dividends? *

Yes
No

Beneficial owner

Are you the owner of the funds used doing business with Michelsen? *

Yes
No

Who is the beneficial owner? *

Name, Social Security Number, address and country.

For what reason are you doing business in your name, but on behalf of another person? *

Source of funds

What is the source of funds using in doing business with Michelsen? *

Other: *

Which country is the source of the funds? *

Iceland
Other

Which country? *

Other: *

Connected party information

Have you, a close family member or a close associate been entrusted with a prominent public position in the last 12 months? *

Yes
No

The name and your relationship to that person: *

What prominent public position? *