Application Form – Brinks Group of Companies.

Brinks Group Of Companies - Account/Membership Application Form

The requested information is required for KYC clearance and registration purposes.

Please complete all sections or mark ‘N/A’ if not applicable. Absence of supporting documentation may result in delay of Registration.

Registered Name

Registered Address

Trading Address

Phone Number

Website

Incorporation Date

Country of Incorporation

Registration Number

VAT Number

Nature of Nusiness

Auditors

Bank Name

Parent Company(If Applicable)

Directors/Partners

Director 1

Director 2

Director 3

Director 4

Director 5

Do any of the Company owners, affiliated companies, directors or key employees have any past criminal convictions or are they involved in any ongoing criminal, civil, or legal proceedings for offences involving fraud, misrepresentation, corruption, bribery, money laundering, accounting irregularities or other related convictions?

Yes No

Are any of the Company owners, affiliated companies, directors or key employees under investigation by an authority in any jurisdiction in respect of an alleged breach of the UK Bribery Act 2010, US Foreign Corruption Practices Act or similar laws in any other jurisdiction?

Yes No

If the response to any of the above is yes, please provide more information.

Does any of the directors, shareholders or ultimate beneficial owners, hold/previously held a prominent public position or function? Have they ever been categorized as a PEP (Politically Exposed Person), a close associate of a PEP or a family member of a PEP by a bank, brokerage firm or any financial institution?

Yes No

If the response to any of the above is yes, please provide more information.

Bank References

Bank

Contact

Phone

Bank

Contact

Phone

Bank

Contact

Phone

Commercial References

Company

Contact

Phone

Company

Contact

Phone

Company

Contact

Phone

Credit Rating

Date Granted

Credit Agency

Rating

Date Granted

Contact Information

Department

Contact Name

Phone Number

Email Address

Upload Files:
Certificate of Incorporation
Tax Clearance
Trading License
Bank Reference

Upload Files

ID/Passport

NOTE:
1. Quotations attract US$500 non-refundable fee for multimodal transportation or shipping quotations.
2. Consultancy fee/ Account membership attracts a non-refundable fee of US$35,000.
3. All transactions attract 50% upfront payment of the quotation or invoice value.

Payments for logistics support services to be made to the bank details below:

Account Name: Brinks Logistics and Forwarding Limited

Account Number: 9010030001301 (ZMW)

Account Number: 9010130032526 (USD)

BANK Name: United Bank of Africa (Z) Limited

Branch: Head Office

Branch Code: 370001

Swift Code: UNAFZMLU

Corresponding Bank: STANCHAR NEWYORK

Swift Code: SCBLUS33

Account Name: UNITED BANK FOR AFRICA ZAMBIA