Know Your Customer Form

1.0 General Information 1.0 معلومات عامة

Application Type *

New Application

Information Update

Authorized Person

Company/Establishment Name

Commercial Registration Number Minimum 10 digits required

Unified No.

Sponsor ID

MOL No.

Issuance Date

Expiration Date

Date of Incorporation

Type of Entity

Country of Origin

1.2 National Address/Postal Address

Building Number

Street Name

District

City

Total Capital Value

Postal Code

Additional Number

Unit No. (if any)

Headquarters Location

No. of Branches

No. of Employees (Range)

Business Activity (as mentioned in the license)

1.1 Contact Information 1.1 بيانات الاتصال

Name *

Position *

Phone Number *

Mobile Number *

Additional Mobile Number *

Email *

Website *

LinkedIn *

Twitter *

Instagram *

Ownership الملكية

Owner's Name

Owner's Title

Owner's Contact Details

Board Members أعضاء مجلس الإدارة

Name

Title

Email

Phone

Share %

Amount

Bank Information (Optional)

Bank Name

Branch

Account Number

IBAN Number

Department Managers مدراء الأقسام

Name

Department

Title

Email

Phone

1.2 Product/Service & Disclosure (Optional)

Note: This section is optional as per management decision.

Product/Service (Optional)

Source of Funds for Future Repayment (Optional)

Disclosures (Optional) الإفصاحات (اختياري)

Has the company experienced any liquidity challenges or financial difficulties?

Yes

No

Please indicate any tax-related issues the entity has encountered

Please disclose any valid convictions against the entity (if any)

Authorized Under

Power of Attorney

BoD Resolution

Shareholders Resolution

Bylaw

Article of Association

Name

Contact Number

Email

Acknowledgement and Consent إقرار وموافقة

I, the undersigned, hereby affirm that all information and documents submitted to FNRCO are true, accurate, and complete. I further undertake to notify the company in writing of any changes to such information immediately upon occurrence, and to update the information upon request or periodically, without any liability to the company.

I consent to allow FNRCO to obtain and verify any necessary information related to the submitted data through relevant governmental platforms or authorized entities in accordance with applicable laws and regulations in the Kingdom of Saudi Arabia.

I agree to the terms and conditions stated above

Customer Name

Date

Signature

Employee Details بيانات الموظف

Name الإسم	Position المنصب	Date التاريخ	Signature التوقيع