1. Company Name
AML and CIP Certification
Company Name, Inc. acting solely in their capacity as discretionary investment advisor hereby certifies to
Company Name USA, Inc., that:
1) Anti money-laundering programs have been implemented by Company Name, Inc.
2) Company Name, Inc. has implemented and will maintain a customer identification program that contain
the following elements:
• Procedures for verifying the identities of customers
• Procedures for maintaining records of the verification process
• Procedures for comparing customers with lists of known or suspected terrorists or terrorist organizations
• Procedures for providing customers with notice that information is being collected to verify their identities
Company Name, Inc. certifies that the above referenced programs have been applied to all customers for
whom investment advisory services are presently performed, regardless of whether or not the customer may
be referred to Company Name USA, Inc.
Company Name, Inc.
By:_______________________
Name: ____________________
Title: _______________________
Date:________________________
COMPANY NAME USA, INC.
123 Main Street, New York, NY 10003
General (212)123-4567 Trading (212) 891-2345 Fax (212) 612-2343
Member FINRA/SIPC