APPLICATION FORM TO OPEN A SWISS BANK ACCOUNT
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   © Micheloud & Cie					     
   Tel  : +41 (0) 21 331 48 48 				     
   Fax  : +41 (0) 21 331 48 40				     
   Mail : info@micheloud.com				     
 							     
 							     
  Please do not hesitate to call  or  email if you need any  
  assistance in filling this form.			     
 							     
  Complete information about our banking products and the    
  latest version of this form can be found on our website    
  at http://www.switzerland.isyours.com/e/banking	     
 							     
      *  indicates obligatory data			     
     (x) indicates Yes, ( ) indicates No		     
 							     
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A. PERSONAL INFORMATION
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      *	CITIZENSHIP 		:

	SECOND CITIZENSHIP 	:  

      *	COUNTRY OF RESIDENCE	:

      *	LAST (FAMILY) NAME	:

      *	FIRST NAME		:

      *	SEX			:

      *	OCCUPATION		:

      *	MARITAL STATUS		:

      *	DATE OF BIRTH
		Day		:
		Month		:
		Year		:  

	ANNUAL INCOME
		Income		:
		Currency	:



B. BANKING NEEDS
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      *	TYPE OF ACCOUNT		:
	(www.switzerland.isyours.com/e/banking 
	 for details)

      *	HOW MUCH WILL YOU DEPOSIT ?
		Amount		:
		Currency	:

      *	IN WHICH CURRENCY DO YOU WANT YOUR ACCOUNT ?
	(You can write several currencies if you 
	 want a multiple currency account)

      *	WHAT IS THE ECONOMIC ORIGIN OF THE MONEY ?




	(This information, as the rest of the form, will be
	 kept strictly confidential. We  need it to satisfy 
	 our due diligence  requirements. We cannot open an 
	 account if we don't know precisely where the money 
	 comes from.)


      *	WHAT ARE YOUR BANKING NEEDS ?

      *	IN WHICH LANGUAGE DO YOU WISH TO COMMUNICATE ?
		Bank contracts	:
		Account officer	:



C. CONTACT INFORMATION
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	SPECIAL INSTRUCTIONS WHEN CONTACTING YOU :



	EMAIL ADDRESS		:

	PHONE NUMBERS
		Home		:
		Work		:
		Mobile		:

	FAX NUMBER		:


We need several addresses to process your application  (up to
3). Some people use only one address, some  put  3  different
addresses. The first one, the "Legal Address", will  be  used
to write bank contracts. The "Address for opening documents",
is where Micheloud & Cie will send you the documents you have
to sign to open the account. Finally, "Address for bank mail",
is used by the bank to send you bank statements.

      * LEGAL ADDRESS
		Street 		:
		City		:
		ZIP code	:
		Country		:

      * ADDRESS FOR OPENING DOCUMENTS
		Send to legal address ( )
		Street 		:
		City		:
		ZIP code	:
		Country		:

      * ADDRESS FOR BANK MAIL
		Send to legal address 			( )
		Keep at bank until further instructions ( )
		Send the the address below 		( )
		  Adressee 	:
		  Street 	:
		  City		:
		  ZIP code	:
		Country		:





C. PAYMENT INFORMATION
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	You can  pay our  account  opening  fee  by  Visa, 
	Mastercard, bank transfer or Western Union. 

      * PAYMENT METHOD
		Bank wire ............................... ( )
		Western Union ........................... ( )
		Credit card ............................. ( )
		  Name on card	   :
		  Card number	   :
		  Expiration date  :
		  Card type	   :

	



D. COMPLEMENTARY INFORMATION
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	SEND YOU THE OPENING DOCUMENTS BY COURIER ....... ( )
	(We charge the cost of the courier extra - it usually 
	 costs around 30$ for  most  countries.  It  normally 
	 arrives in 2-3 days)


      * I READ AND ACCEPTED YOUR CONDITIONS ............. ( )
	www.switzerland.isyours.com/e/banking/conditions.html

      * I FILLED THIS QUESTIONNAIRE HONESTLY ............ ( )

      * MICHELOUD & CIE DID NOT ENCOURAGE ME TO BREAK
	ANY LAW ......................................... ( )

      * HOW DID YOU LEARN ABOUT US ?


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|  When filled, please send to : 			    |
|							    |
|	Micheloud & Cie					    |
|	Grand-Chene 8					    |
|	CP 3332						    |
|	CH-1002 LAUSANNE				    |
|	SWITZERLAND					    |
|							    |
|	Fax 	: + 41 (0) 21 331 48 40			    |
| 	Phone	: + 41 (0) 21 331 48 48 		    |
|	Email	: banking@switzerland.isyours.com	    |
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