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A. DESCRIPTION
Personal data:
Surname
*
First name
*
Gender:
*
F
M
Date of birth
*
Format: DD.MM.YYYY
Place of birth
*
Country of birth
*
Nationality 1
*
Nationality 2
In Luxembourg since
*
Civil status
*
single
maried
divorced
separated
widowed
civil partnership (PACS)
Name of spouse / partner (If you both want to open an account, both account holders must complete this form, even for a joint account)
Legal address / tax residence
Street, No.
*
Postal code
*
City/Town
*
Country of legal residence
*
Is your tax residence different from your legal address?
*
Yes
No
Country of tax residence
*
Tax identification number (For employees from Luxembourg, please enter your social security number)
*
Contact details
Mobile phone number
*
Format: +352 123 456
Email
*
Format: email@example.com
Branch
*
Select a branch
Bascharage
Belval Plaza
Bertrange/Concorde
Bettembourg
Bonnevoie
Centre
Cloche d'or
Diekirch
Differdange
Dudelange
Echternach
Esch/Alzette
Ettelbruck
Gare
Gasperich
Grevenmacher
Hesperange
J.F. Kennedy
Kayl
Kirchberg
Mamer
Merl / Belair
Mersch
Mondercange
Mondorf
Niederanven
Place de MetzPlace de Metz
Pétange
Redange-Attert
Schifflange
Steinfort
Strassen
Walferdange
Wemperhardt
Wiltz
Preferred Spuerkeess branch
Regulatory status:
Are you a "US Person" within the meaning of the Foreign Account Tax Compliance Act (FATCA)?
*
Yes
No
Do you (or any of your close associates) hold a public or political position (PEP)?
*
Yes
No
Employment:
Occupation
*
Employer
*
Field of activity
*
* Mandatory field
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