Customer's Name (as per TL) ATLAS GROUP DWC-LLC
CIF No. (if applicable) Relationship Opening Date
1. CUSTOMER INFORMATION
If UAE, is it a flexi desk/shared
□ Yes □ No
workspace setup?
If UAE, is it an Offshore setup? □ Yes □ No
If Yes, provide Domicile Country of
□ UAE Head Office _____________________________
Country of Incorporation
If UAE, is it a Branch of a Foreign □ Yes □ No
Entity Setup?
If Yes, provide Domicile Country of _____________________________
Head Office
□ Non-Resident (Provide Country): _______________________________________________________________
Type of Company □ Operating Company □ Holding Company
Type of Activity □ Service Provider □ Trading of Goods (Provide Details) _____________________________
Licensed Business Activity
Industry Description and Management Consultancies, Marketing Research & Consultancies, Computer Systems & Communication
Nature of Business Activity Equipment Software Design & Internet Content provider
Countries of Operation UAE
Business Operating Address 3rd Floor, A3, Dubai South Business Center
Company Website https://atlasgroup.tech/
Years in Business 4 Number of Employees
Provide details on the company’s background and Operating Model
2. PURPOSE AND INTENDED USE OF ACCOUNT
□ Supplier / Vendor / Customer □ Business Expense
Purpose of New/Additional Account □ Inter-Company Payments
Payments (Salary / Administration)
Opening/Reactivation of Account
□ Others (Provide Details) _______________________________________________________________
Indicate the banking products and □ Liability Products □ Asset Products □ Investment Products
services expected to be
availed/availed by the customer? □ Others (Provide Details) _______________________________________________________________
3. OTHER BACKGROUND
Monthly Source(s) of Income ☐ Sale proceeds of products & services ☐ From Shareholders ☐ Others (Provide Details): _________
Estimated Annual Net Profit (AED) AED 50,000 Company’s Annual Turnover (AED) 250,000
☐ < AED 250K ☐ AED 250 – 500K ☐ AED 500K – 1 Million
Total Estimated Net Worth (Wealth)
☐ AED 1 Million – 3 Million ☐ AED 3 Million – 5 Million ☐ > AED 5 Million (Specify): _________
Does the entity or the owner(s) have any direct or indirect business or banking relationship with any of the sanctioned
countries/entities/individuals or the customer is dealing with any products which are originated or destined to the □ Yes □ No
sanctioned countries?
Is the entity involved in any prohibited activity as per the DIB policy? □ Yes □ No
4. MONTHLY ANTICIPATED TRANSACTIONAL ACTIVITY
a. Cash Deposits Withdrawals Purpose of Transaction
Number of transactions 0 0
Total value of transactions (in AED) 0 0
b. Cheques Deposits Withdrawals Purpose of Transaction
Number of transactions 0 9
Accounting Fee and Other Bank Charges
Total value of transactions (in AED) 0 4158,48
c. Internal Transfers from/to other customers within DIB Inward Outward Purpose of Transaction
Number of transactions 0 0
Total value of transactions (in AED)
0 0
d. Wire Transfers Inward / From Outward / To Purpose of Transaction
Number of transactions 0 0
Total value of transactions (in AED) 0 0
Countries from / to funds are anticipated
Will the customer’s transactions include those with any sanctioned countries? □ Yes □ No
Anticipated Annual Transaction ☐ < AED 500K ☐ AED 500k – 1 Million ☐ AED 1 Million – 3 Million
Turnover with DIB (AED) ☐ AED 3 Million – 5 Million ☐ AED 5 Million – 10 Million ☐ > AED 10 Million (Specify): ________
5. EXISTING RELATIONSHIPS WITHIN DIB
Does the Customer hold any existing relationship within DIB in individual capacity or as a related party to any
□ Yes □ No
entity? (If Yes, provide details below)
Account Holder’s Name CIF Number Business Segment
1. □ Individual □ Entity
2. □ Individual □ Entity
3. □ Individual □ Entity
6. EXISTING RELATIONSHIPS WITH OTHER BANKS
Does the Customer hold any existing relationship with other banks? (If Yes, provide details below) □ Yes □ No
Estimated Relationship
Account Holder’s Name Bank Name and Country Banking Since
Value (AED)
1. □ Individual □ Entity
2. □ Individual □ Entity
3. □ Individual □ Entity
7. MAJOR SUPPLIER AND CLIENTS DETAILS
Transaction
Major Suppliers Country Business Activity Website
Currency
1. Intellect Chartered Accountant UAE Accountancy services https://intellectacc.com/ AED
2. FirstBIT Technologies UAE IT Services https://firstbit.ae/ AED
3. Midlink General Trading L.L.C UAE IT Services - AED
Transaction
Major Clients Country Business Activity Website
Currency
1. SoCoSo Software Consulting Solutions GmbH Germany IT Services https://www.socoso.net/ Euro
2. Veda Telecom FZCO UAE IT Services - AED
3. Steadfast Ways Marketing Management UAE Marketing - AED
8. OTHER ASSOCIATED COMPANIES
Country of Account with DIB?
Name of Entity Business Activity Website
Incorporation
□ Yes If yes, CIF:
1.
□ No ____________
□ Yes If yes, CIF:
2.
□ No ____________
□ Yes If yes, CIF:
3.
□ No ____________
9. RELATED PARTY DETAILS (insert another page for additional related parties)
Are all UBOs holding 15% or more and other related parties (including beneficiaries, or controlling persons) to the
□ Yes □ No
account have been identified below?
Related Party 1 Related Party 2 Related Party 3
□ Shareholder / UBO □ Shareholder / UBO □ Shareholder / UBO
□ Director □ Director □ Director
Related Party Type □ Authorized Signatory □ Authorized Signatory □ Authorized Signatory
□ Others _______________________ □ Others _______________________ □ Others _______________________
□ Individual □ Entity □ Individual □ Entity □ Individual □ Entity
PEP Status □ Yes □ No □ Yes □ No □ Yes □ No
*Full Name
Christoph Gsottbauer Christoph Gsottbauer
(as per identification document)
CIF No. (if applicable)
*Date of Birth/ Incorporation 10-02-1981 10-02-1981
(DD-MM-YYYY)
Country of Birth (for Individual) Austria Austria
*Nationality (for Individual) Austria Austria
*Country of Residence/Incorporation UAE UAE
Physical Address 6802, Cayan Tower, Dubai, Marina 6802, Cayan Tower, Dubai, Marina
Passport Number 3489739 3489739
Passport Expiry Date 29-08-2028 29-08-2028
Visa Expiry Date 25-11-2023 25-11-2023
Shareholder of ( Company Name ) Blockchain Investment LTD ELLIPTIC FOR INFORMATION TECHNOLOGY CONSULTANTS EST.
Shareholder % ( in Company ) 100.00% 100.00%
□ Salary □ Salary □ Salary
□ Savings □ Savings □ Savings
Source of Income and
□ Other Businesses □ Other Businesses □ Other Businesses
Source of Wealth
□ Family Inheritance □ Family Inheritance □ Family Inheritance
□ Others _______________________ □ Others _______________________ □ Others _______________________
Brief Profile, Past Experience,
Businesses Owned
(Attach CV for Individual;
Website details for entity)
