This section captures essential identification and verification details for the primary account holder granting authority. Accurate information is critical for compliance, risk assessment, and legal validity across all jurisdictions.
Full Legal Name (as per government-issued identification)
Have you ever been known by any other legal names, including maiden names, previous married names, or legal name changes?
Date of Birth
Gender Identification
Female
Male
Non-binary
Prefer not to disclose
Prefer to self-describe
Country of Birth
Current Nationality
Do you hold any additional nationalities, citizenships, or have permanent residency status in any other jurisdictions?
Primary Country of Tax Residency (CRS/FATCA jurisdiction)
Taxpayer Identification Number (TIN) for primary tax residency
Are you tax resident in any additional jurisdictions?
Full Residential Address (must be verifiable with utility bill or bank statement)
Is your mailing address different from your residential address?
Primary Contact Telephone Number (including country code)
Secondary Contact Telephone Number
Primary Email Address for Official Communications
Type of Primary Government-Issued Identification Document
Passport
National Identity Card
Driver's License
Government-issued Photo ID
Identification Document Number
Identification Document Expiry Date
Can you provide a second form of government-issued identification?
Account Number(s) and/or Relationship Number(s) for which authority is being granted (list all)
Current Marital Status
Single
Married
Domestic Partnership
Divorced
Widowed
Legally Separated
Are you currently or have you been within the last 5 years a Politically Exposed Person (PEP), Senior Public Official, or Head of International Organization?
Detailed Description of Source of Wealth (how you accumulated your overall wealth)
Detailed Description of Source of Funds for this specific account relationship
Estimated Total Net Worth (in USD equivalent)
Current Professional Status
Employed (Executive/Senior Management)
Employed (Professional)
Self-employed/Business Owner
Retired
Investor
Trust Beneficiary
Other
Do you own or control any corporate entities, trusts, or legal arrangements that require disclosure under beneficial ownership regulations?
Comprehensive details regarding the individual or entity being granted authority. This information enables proper due diligence, conflict of interest screening, and assessment of suitability for the requested powers.
Agent's Full Legal Name (individual or authorized representative)
Has the agent ever used other legal names?
Agent's Date of Birth (if individual)
Agent's Country of Nationality/Registration
Agent's Primary Country of Tax Residency
Agent's Taxpayer Identification Number
What is the agent's relationship to you (the primary account holder)?
Licensed Wealth Manager/Investment Advisor
Attorney/Legal Representative
Family Member (Immediate)
Family Member (Extended)
Corporate Trustee
Business Partner/Associate
Personal Friend
Other Professional Advisor
Agent's Full Residential or Registered Business Address
Agent's Primary Contact Telephone
Agent's Primary Email Address
Agent's Government ID Type and Number
Agent's ID Expiry Date
Is the agent currently or has been within the last 5 years a Politically Exposed Person (PEP)?
Does the agent have any criminal record, regulatory sanctions, or adverse financial history?
Agent's Relevant Professional Qualifications & Certifications
Qualification/Certification Name | Awarding Institution | Award Date | Expiry/Renewal Date | Verified by HR or issuing body? | |
|---|---|---|---|---|---|
Chartered Financial Analyst (CFA) | CFA Institute | 6/15/2018 | 6/15/2028 | ||
Do you have any existing business, personal, or financial relationships with the agent outside of this authority delegation?
Will there be more than one designated agent acting jointly or severally?
Do you wish to designate a successor agent if the primary agent becomes incapacitated or resigns?
Precise definition of the authority being delegated is essential for operational clarity and legal enforceability. This section establishes the specific powers, monetary boundaries, temporal limits, and conditional restrictions governing the agent's actions.
Type of Authority Being Established
General Durable Power of Attorney (broad financial powers)
Limited Power of Attorney (specific powers only)
Trading Authorization Only (investment transactions)
Account Delegation (view/access only)
Custom Hybrid Authority (mix of powers)
Specific Powers Granted to Agent (select all that apply)
View account balances and holdings
Execute buy/sell trades across all asset classes
Withdraw and transfer funds to third-party accounts
Receive account statements and tax documents
Communicate with relationship managers and advisors
Appoint sub-agents or advisors
Establish new accounts or products
Modify investment mandates or risk profiles
Pledge assets as collateral for loans
Vote proxies and corporate actions
Redeem or subscribe to investments
Amend account details or beneficiaries
Financial Thresholds & Transaction Limits (all amounts in USD equivalent)
Transaction Type | Per Transaction Limit | Daily Aggregate Limit | Monthly Aggregate Limit | Annual Aggregate Limit | Requires Dual Authorization? | |
|---|---|---|---|---|---|---|
Securities Purchase | $500,000.00 | $1,000,000.00 | $5,000,000.00 | $20,000,000.00 | ||
Securities Sale | $500,000.00 | $1,000,000.00 | $5,000,000.00 | $20,000,000.00 | ||
Cash Withdrawal | $100,000.00 | $250,000.00 | $1,000,000.00 | $5,000,000.00 | Yes | |
Third-Party Transfer | $50,000.00 | $100,000.00 | $500,000.00 | $2,500,000.00 | Yes | |
Foreign Exchange | $250,000.00 | $500,000.00 | $2,500,000.00 | $10,000,000.00 | ||
Maximum Total Account Value the agent can manage under this authority (USD equivalent)
Asset Classes Authorized for Trading/Investment (select all applicable)
Equities (stocks/shares)
Fixed Income (bonds, treasuries)
Mutual Funds & ETFs
Alternative Investments (hedge funds, private equity)
Structured Products & Derivatives
Foreign Exchange (FX)
Commodities & Precious Metals
Real Estate Investment Trusts (REITs)
Cryptocurrency/Digital Assets
Private Placements & IPOs
Are there geographic or jurisdictional restrictions on where the agent can execute transactions?
Should this authority have a specific expiration date or be subject to automatic review?
Automatic Revocation Triggers (select all that apply)
Account holder's incapacitation or death
Agent's incapacitation or death
Agent's criminal conviction or regulatory sanction
Material breach of authority limitations
Account value falling below threshold
Change in agent's PEP status
Discovery of material conflict of interest
Written notice by either party
Change in regulatory regime
Specific Restrictions or Prohibited Actions (negative covenants)
Do you require real-time notifications for all agent activities?
Should certain high-risk transactions require dual authorization (agent + account holder)?
Sample Transaction Scenarios & Expected Outcomes (for operational clarity)
Scenario Description | Agent Authority | Conditions or Notes | |
|---|---|---|---|
Purchase $50k of AAPL stock during market hours | Permitted | Within daily limit, no conditions | |
Withdraw $150k cash to new third-party account | Conditional | Requires pre-approved beneficiary verification | |
Subscribe to private equity fund minimum $1M | Prohibited | Exceeds single transaction limit; requires separate approval | |
Change account mailing address to agent's address | Prohibited | Account holder must change own address | |
Sell entire portfolio during market volatility | Conditional | Requires verbal confirmation if >$5M | |
Anti-Money Laundering (AML) compliance and identity verification protocols are mandatory for all authority delegations. This section ensures regulatory adherence and protects against financial crime, fraud, and unauthorized access.
Primary Source of Wealth Documentation Provided (select all)
Audited financial statements (3 years)
Tax returns (3 years)
Sale of business documentation
Inheritance documentation & probate
Divorce settlement documentation
Employment contracts & compensation history
Investment portfolio statements
Real estate sale documentation
Gift letters with donor verification
Upload Source of Wealth Documentation (consolidated PDF preferred)
Upload Source of Funds Documentation for initial account funding
Are you (account holder) a close associate or family member of a Politically Exposed Person (PEP)?
Is the designated agent a close associate or family member of a PEP?
Do you consent to ongoing adverse media and sanctions screening for both parties?
Have you or the agent ever been subject to regulatory enforcement, fines, or sanctions?
Transaction Monitoring & Reporting Frequency
Real-time monitoring with immediate alerts
Daily consolidated reporting
Weekly summary reports
Monthly detailed statements
Quarterly performance reviews
Expected Transaction Patterns & Profile (for anomaly detection)
Transaction Type | Expected Monthly Volume | Primary Counterparties | Typical Jurisdictions | High Risk? | |
|---|---|---|---|---|---|
Equity trades | $2,000,000.00 | Major exchanges | US, UK, EU | ||
Fixed income purchases | $500,000.00 | Investment grade issuers | US, Switzerland | ||
Third-party transfers | $300,000.00 | Family members | Domestic | Yes | |
FX conversions | $1,000,000.00 | Major banks | Global | ||
Is there any ultimate beneficial owner different from the account holder?
Will any third parties be making payments into or receiving payments from this account?
Do you or the agent have any exposure to high-risk jurisdictions (as defined by FATF grey/black lists)?
Enhanced Due Diligence Measures to be Applied (select all applicable)
Source of funds verification for every transaction >$100k
Quarterly face-to-face or video verification calls
Annual re-certification of authority
Independent legal opinion on authority validity
Blockchain analytics for crypto transactions
Beneficial ownership re-verification every 2 years
Adverse media screening every 6 months
Transaction pattern analysis by compliance team
Required Documentation Checklist & Verification Status
Document Type | Provided by Account Holder | Provided by Agent | Verification Method | Verifier Name/Position | Verification Date | |
|---|---|---|---|---|---|---|
Government-issued photo ID | Certified true copy | Relationship Manager | 1/15/2025 | |||
Proof of residential address | Original sighted | Compliance Officer | 1/15/2025 | |||
Tax residency documentation | Notarized | Tax Advisor | 1/10/2025 | |||
Professional license/credentials | Digital verification | HR Department | 1/12/2025 | |||
Source of wealth documents | Apostilled | Legal Counsel | 1/8/2025 | |||
Final legal declarations, operational protocols, and binding signatures. This section formalizes the authority delegation, establishes compliance acknowledgments, and creates an audit trail for regulatory and legal purposes.
Preferred Legal Jurisdiction for Governing Law
Account holder's primary tax residency
Agent's primary jurisdiction
Financial institution's domicile
Neutral international jurisdiction (e.g., English law)
Multiple jurisdictions (specify)
Do you require this authority to be effective immediately upon signing?
I acknowledge that I have read, understood, and accept all terms and conditions of this authority delegation, including liability limitations and indemnification clauses.
I confirm that all information provided in this intake form is true, accurate, and complete to the best of my knowledge.
I understand that the financial institution reserves the right to reject any transaction that violates policy, exceeds limits, or raises compliance concerns, even if technically within granted authority.
I acknowledge the risks associated with granting third-party authority, including potential fraud, negligence, or misuse, and accept responsibility for monitoring the agent's activities.
I consent to the fees and charges associated with third-party authority setup, maintenance, and transaction processing as outlined in the fee schedule.
Do you consent to audio recording of all phone calls where the agent transacts on your behalf?
Do you consent to video verification calls for high-value transactions or periodic compliance reviews?
Preferred Communication Methods for Authority-Related Matters
Secure encrypted email
Postal mail to registered address
Telephone call to verified number
Secure messaging via client portal
In-person meetings at branch office
Video conference calls
Does this authority arrangement require notarization or legalization for your jurisdiction?
Required Signatures & Authority Execution
Signatory Name | Capacity (Account Holder/Agent/Witness) | Signature Method | Execution Timestamp | Location (City/Country) | Signature Verified | |
|---|---|---|---|---|---|---|
Alexandra Maria Thompson | Account Holder | Digital signature with OTP | 1/20/2025, 2:30 PM | London, UK | ||
Marcus Chen | Agent | Digital signature with OTP | 1/20/2025, 2:35 PM | New York, USA | ||
Isabella Rodriguez | Witness (Compliance Officer) | Physical signature | 1/20/2025, 3:00 PM | London, UK | ||
Do you require independent legal counsel to review this authority delegation before execution?
Frequency of Periodic Authority Review and Re-confirmation
Annually
Every 2 years
Every 3 years
Upon significant life event
Upon request by either party
No scheduled review (continuous until revocation)
Emergency Contact Person (if authority issues arise)
Emergency Contact Telephone
I consent to the processing of my personal data and special category data (if any) as defined by applicable data protection regulations for the purposes of establishing and maintaining this authority delegation.
I understand my rights regarding data access, rectification, erasure, and portability, and know how to exercise them with the institution's Data Protection Officer.
Additional Comments, Special Instructions, or Qualifying Statements
Account Holder Digital or Physical Signature
Designated Agent Acknowledgment & Acceptance Signature
Final Execution Date