SOURCE OF FUNDS AND SOURCE OF WEALTH DECLARATION FORM

Name of Investor: :
Name of Fund:: :

Anti-money laundering rules have evolved over the years and we are required to understand the
origin of an investment prior to completing any transaction. Please provide sufficient information to
allow us to understand how you have obtained the funds for your investment and the source of
wealth. Kindly be informed that all information and documents will remain confidential and secure.

I/We hereby confirm that investments made into the above-named Fund:

 Are not made on behalf of a third party;

 The funds invested are derived from legitimate sources and are not linked and/or
derived from criminal origin, of whatsoever nature, and in particular do not
constitute the proceeds of money laundering or terrorist financing; and
 Originate from the following source: (you can mark more than one option)

 Capital of company/Dividends or income from business:

If yes, please provide the details, including company name and amount:
_____________________________________________________________________
_____________________________________________________________________
 Gift/Inheritance:
If yes, please give details, including origin, date received and amount:
_____________________________________________________________________
_____________________________________________________________________
 Professional salary:
Name of Employer:______________________________________________________
Occupation: ___________________________________________________________
Address of Emp: ________________________________________________________
No of years in Employment: _________ Gross Annual Income ___________________
  Profit from sold or maturing investments:
If yes, please provide the date of liquidation/sale and sale amount:
_____________________________________________________________________
_____________________________________________________________________
 Profits from property sale:
If yes, please provide the date and total sale amount:
_____________________________________________________________________
_____________________________________________________________________
 Profits from sale of company:
If yes, please provide the name and nature of the company, date and amount of sale:
_____________________________________________________________________
_____________________________________________________________________
 Compensation payment:
If yes, please provide details on the type and amount of compensation received:
_____________________________________________________________________
_____________________________________________________________________
 Pension (please complete the section Professional Salary)
 Other, please specify:
_____________________________________________________________________
_____________________________________________________________________

Please note that evidence and/or back-up documentation of this source, as detailed in the
guidelines must be provided for all high risk clients and Apex reserves the right to request further
information and back-up documentation if deemed necessary.

I declare that the information provided in this form is true and complete. I agree to provide
Apex Fund Services (Malta) Limited with any further information or documentary evidence
in respect of the investment upon request.

Signature of investors: ____________________________

Signature of investors: _____________________________

Date ___ / ______ / ________

 SOURCE OF WEALTH AND FUNDS GUIDELINES

Description of Documents to be provided

Source (upon further request)
Income from salary One of the following:
 Payslip (latest 3 months )
 Letter from employer confirming salary & years in employment
 Bank statement showing receipt of salary
Maturity or surrender of One of the following:
life policy  Closing statement
 Letter from insurance
Sale/liquidation of One of the following:
investments  Certificate/Contract Note/Statement
 Bank Statement showing the redemption proceeds incoming
 Signed letter from regulated accountant on headed paper
Sale of property One of the following:
 Letter from solicitor or regulated accountant
 Copy of the sale contract
Company Sale One of the following:
 Letter from solicitor detailing company sale
 Copy of the sale contract and statement showing proceeds
Inheritance One of the following:
 Grant of probate
 Signed letter from solicitor or estate trustee on headed paper
 Last will
Divorce Settlement or any One of the following:
other form of settlement  Copy of the court order/agreement
or compensation  Letter from solicitor detailing settlement
Company Profits One of the following:
 Copy of latest audited company accounts
 Confirmation on the nature and business of the company provided
from recognised accountants
Retirement Income One of the following:
 Pension statement
 Bank statement showing the pension income
 Letter from the paying institution
Employer Premium One of the following:
 Employer letter on headed paper confirming the amount to be paid
 Copy of the last audited company accounts
Fixed deposit – saving  Saving statement
Dividend payment One of the following:
 Dividend contract note
 Bank statement showing the income
 Letter detailing dividend details signed by recognised accountant
 Set of company account showing the dividend details

The above list is provided for guidance purposes only, and each case will be considered for it’s own
merits