Paul F. Cammareri

CONNECT

Address:

132 West 36th Street, Suite 510
New York, NY 10018

Phone:

(646)722-7772

CIP Notice and Request Form

     CIP NOTICE AND REQUEST FORM 

 

     Thank you for opening your investment account with us.  In addition to the other

forms and information required in order to establish your account, recent changes in

the law require that we provide all our new accounts with this notice concerning our compliance with certain anti-money laundering requirements applicable to all financial firms, according to our firm’s Customer Identification Program (“CIP”), established pursuant to applicable provisions of the USA PATRIOT Act of 2001.

 

     This is to inform you that, pursuant to recent applicable statutory and/or regulatory

requirement or guidance, supplemental customer identification information will be gathered to provide further assurance that customers opening accounts with or through National Securities Corp. have provided accurate and complete customer identification information.  This is in an effort to preclude individuals or entities representing terrorist groups, drug cartels, criminal organizations, or their associates, or others known to have engaged in money-laundering activities in the past, from using this firm, or any of its associated persons, as an unwitting conduit for financing their activities.  We appreciate

your cooperation in helping us fulfill the goals of the USA PATRIOT Act.

 

IN THIS REGARD, PLEASE RETURN TO US COPIES OF AT LEAST ONE ITEM

LISTED BELOW AND/OR ALL SUPPLEMENTAL INFORMATION REQUESTED FOR OUR FILES (IN ADDITION TO THE NEW ACCOUNT FORM AND ANY OTHER FORMS):

 

_____    Driver’s License                                        _____     Articles of Incorporation

 

_____     Passport                                                    _____     Partnership Agreement

 

_____     Birth Certificate                                        _____     Trust Certificate

 

_____     Photo ID                                                   _____     Entity Documentation

 

_____     Background Documents                           _____     Governmental License/Permit

 

_____     Personal References                                  _____     Business References

 

_____     Other _________________________________________________________

 

                          _________________________________________________________

 

                          _________________________________________________________

 

If you have any questions regarding the foregoing, contact your registered representative

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