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Membership Application
Submitting of online Application for membership within the Association is the first step in obtaining of membership. Perspective Applicants are requested to read carefully
Rules & Regulations
,
Code of Conduct
,
Web Terms & Conditions
,
Web Communications Policies
and
Due Diligence Policy
before filling and submitting the present online Application.
Please be aware that directors of the Association are deciding concerning approval or rejection of the present Application, and that perspective applicants will be informed via e-mail about taken decision. All fields marked with "
*
" are mandatory to be filled with proper information, since it is vital in reviewing and deciding concerning approval or rejection of the present online Application.
Application requires uploading of electronic documents-scanned copies of Passport, utility bills (not older than three months) and corporate documents-please upload them in PDF or any picture format.
Applications must be filled and submitted by individual person, since membership cannot be granted without determination of ultimate beneficial ownership in the case that corporate membership is requested-see section "Corporate Membership" of the present online Application.
All information received are confidential and will be treated as confidential. Personal information will not be shared or forwarded to third parities without prior consent given by the applicant.
*
Indicates required field
Applicant Identification
This application must be filled and submitted by physical person-if you apply on behalf of company related to you, you can obtain corporate membership, but the Association will treat you as beneficial owner of introduced company for appropriate type of membership in the case that membership is granted.
Name
*
First
Last
Previously held names (if any)
*
First
Last
Passport
*
Place & Date of Issuing
*
Place/DD/MM/YY
Valid Until
*
DD/MM/YY
Citizenship
*
Please Upload Scanned Passport
*
Max file size: 20MB
Contact Details
Hereby provided details will be used in future communications, unless their change will be advised by the member.
Residential Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Mobiile Phone
*
Email
*
Other Contacts
SKYPE Name
*
Facebook
*
Know Your Client Details
Source of Income, Proof of Residential Address & Due Diligence Record
The continuing threat of money laundering is most effectively managed by understanding and addressing the potential money laundering risk, associated with customers and their transactions (”Know Your Clients”-KYC). Based on Wolfsberg AML Principles,
Association
ECOPOWER
and its corporate directors have implemented KYC Policy to assist members, its clients, associates and administrators to manage money laundering risk. Information hereby requested is fully in accordance with Due Diligence Policy of the Association, and will be treated as confidential.
Source of Income
*
Salary
Commissions
Dividends
Rental Income
Other
If you tick "Other" above, please describe your source here
*
Employment Status
*
Hired Employee
Self Employed
Retired
Unemployed
Other
If you tick "Other" above, please describe your status here
*
Serving Bank
*
Website of serving bank
*
IBAN/Account Number
*
Please Upload Proof of Address
*
Max file size: 20MB
Following Due Diligence Policy of the Association, applicants must provide the proof of residential address.
The valid proof could be:
Copy of the recent utility bill (electricity, telecom, etc), or
Copy of the recent bank statement, or
Copy of internal passport (for citizens of Russian Federation).
Please upload scanned copy of the Proof of Residential Address, not older than three months.
Employment Information
Current Place of Work/Company's Name
*
Company's Website
*
Company's Phone Number
*
Due Diligence Record
Have you ever been involved in a legal violation/breach in any jurisdiction?
*
Yes
No
Have you ever been under a tax investigation of the authorities in any country?
*
Yes
No
Address of the Company
*
Line 1
Line 2
City
State
Zip Code
Country
Employment Position
*
Are you (or members of your family) politically exposed in any country?
*
Yes
No
Have you ever been a bankrupt or an employee of the company that went bankrupt in any jurisdiction of the world?
*
Yes
No
If you answer "Yes" on any of questions above, please provide detailed info here:
*
Corporate Membership
In the case that your intention is to obtain corporate membership for related company to you, please provide us with all details provided bellow, since they are vital for reviewing of the present online Application. If you are not ultimate beneficial owner of the Company hereby introduced, please be aware that professional membership cannot be granted without given consent from ultimate beneficial owner-without such consent, provided that all other requirements are matched, professional membership might be granted personally to the Applicant, and he will be treated as beneficial owner of entities delivered to him in the course of membership's benefits.
Name of the Corporate Applicant
*
Jurisdiction of Incorporation
*
Registration Number & Date of Registration
*
Registration Number/DD/MM/YY
Applicant's Relation with the Company
*
Beneficial Owner/Shareholder
Director
Executive
Upload Certificates of Incorporation & Officers
*
Max file size: 20MB
Type of Legal Entity
*
Private
Public
State/Governmental
Professional Partnership
Private Public Partnership
Business Line
*
Manufacturing
Design/Projecting
Services
Investments/Holdings
Financial Services
Contact Details
In the case that corporate membership will be granted, hereby provided details will be used in official communications.
Business Address
*
Line 1
Line 2
City
State
Zip Code
Country
Office Email
*
Office Phone Number
*
Official Website
*
Facebook
*
Twitter
*
SKYPE
*
VIBER
*
Officers & Servants
Director's Full Name
*
Name of the Prime Bank
*
Lawyer/Legal Representatives
*
Name
Accountant
*
Name
Secretary (if any)
*
Bank's Website
*
Lawyer's Website
*
Accountant's Website
*
Undertaken Businesses
Business Description
*
Describe undertaken business by the company-main business line, covered markets, number of employees. covered markets, desired way of business development
Main Products/Services
*
Provide information about main products/services, such as brand name, trademark, applications, etc
Geographical Spread of Business
*
EU
Russian Federation & CIS
China
India
Australia
Japan
Asia-Pacific
USA & Canada
Latin America
ISO Management Standard
*
Yes
No
ISO
*
ISO 14000 Environmental management
ISO 26000 Social responsibility
ISO 50001 Energy management
ISO 31000 Risk management
ISO 27001 Information security management
ISO 45001 Occupational health and safety
Other
Certified/Licensed Products
*
Yes
No
Quality Certificates/Licenses
*
CE Mark
GOST
ISO
Financial License
Fiduciary License
Bank License
Other
Intellectual Property Rights
*
Yes
No
IP
*
Patent
Industrial Design
Copyright
Trade Mark
Other
Indemnity Insurance Coverage
*
Yes
No
Covered by
*
Please provide the name and jurisdiction of incorporation of insurance company that provides coverage
Audited Financial Statements
*
Yes
No
Audited by
*
Please provide the name and jurisdiction of incorporation of auditing firm that audits financial statements
Applicant's Confirmation
Acceptance of Rules and Regulations
*
Accepted
Not Accepted
Participation Subscription Payment
*
Affiliate Package [1,000 E]
Professional Package [10,000 E]
Sponsorship [30,000 E]
Other Amount
Tick appropriate-minimum participation subscription concerning affiliated membership is 1,000 EUR, and minimum participation subscription concerning professional membership is 10,000 EUR. If you prefer to pay other amount, please tick "Other Amount" and enter Amount of Participation Subscription.
Other Amount [if it is not selected above]
*
I confirm that provided information in the present online Application are true, correct and lawful, and I fully understood and accept terms and conditions of membership within
Association
ECOPOWER
described in Memorandum and Articles of Association, Code of Conduct, Web Terms & Conditions, Web Communication Policies.as well as Due Diligence Policy, published at this website, as well as, that I haven’t received any financial or tax advice from
Association
ECOPOWER
, its directors and employees concerning my decision to contribute through submitting the present online Application and payment participation subscription in the course of the present online Application.
Submitting of the present online Application is expression of my free will and my sole decision made under clear understandings of all aspects related to desired membership.
I undertake to pay selected participation subscription in accordance with instructions that
Association
ECOPOWER
shall send me in the course of reviewing of the present online Application. I'm aware that selected amount of Participation Subscriptions will be invoiced by the corporate director, and that an invoice will be sent in electronic form upon received application, with detailed payment instruction.
In the case of payment via banking wire transfer, I understand that I have to cover relevant bank charges in order to secure that net Participation Subscription will be received.
In the case of online payments, I understand and agree that my payment card will be debited for amount of selected Participation Subscription, and that I'm not responsible for any charges related to processing of approved online payment.
Affiliate Introduction
*
Yes
No
If answer is "Yes" please provide Affiliate's Membership Certificate Number
*
Submit
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