Customer Information Form

IRTH

* Title

* Full Name (Name as per passport)

* Primary Email

* Primary Contact Number

Secondary Email

Secondary Contact Number

Existing Customer

Contact Details

* Title

* Name(individual as per passport)

* Passport No

* Passport Expiry

Emirates ID No

Emirates ID Expiry Date

* Date of Birth

* Primary Contact Number

Secondary Contact Number

* Primary Email

Secondary Email

* Nationality

* Country of Residence

* Full Address

* Building Name

Tax Registration Number (For Individuals)

* City

If Purchaser is a company, insert details below and complete details above for the company representative

Company Name

Trade License Number

Tax Registration Number

Agent Details

Agent Name

Agency Name

Source and Method of Payment

* Source Of Fund

Method of Payments

Cash

Cheque

Bank Transfer

Card

Crypto

(Out of salaried, passive income, business income, inheritance, loan, mortgage, pensions, proceeds of investment, winning from lotteries or through gambling etc.)

PEP Declaration (Politically Exposed Person)

A PEP is a senior officials in government, political organizations or government-owned organizations, or has relatives or close associates of any such officials. Please Confirm

Yes, I am PEP

No, I am Not PEP

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IRTH Urban Development

B1501, Opus Tower, Business Bay, Dubai, UAE