Customer Operation

<%----%> Japan Money Express Co.Ltd
Customer Registration Request

Customer Information: ()
Full Name:

Personal Information
Country:		Native Country :
Address:
City:		Zip Code :
Date of Birth :
Occupation :
Visa Status :		Employee Business Type :
Source Of Fund :		Gender:
Monthly Income :		Telephone No. :
E-Mail ID:		Mobile No. :
Name of Employer :
Remarks:
Security Information
Verification Id Type:		Verification Type No. :
Issue Date:		Expiry Date:
Beneficiary Information
Country:
Full Name:	Native Country:
Beneficiary Address:	City:
Mobile:	Id Type:
Id Number:	Place Of Issue :
Relationship To Beneficiary:
Purpose Of Remittance:
Payment Mode:
Agent/Bank:	Beneficiary A/c:
Agent/Bank Branch:	Remarks:
私は、本依頼書に記載されているジャパンマネーエクスプレス株式会社の「海外送金利用規約」の内容に同意します。私の依頼する送金は、北朝鮮及びイランとは関係無い取引であり、反社会勢力と一切の関りはありません。私は「外内国の重要な公的な地位にある者」ではありません。また申込書に表示された内容について間違いが無い事を確認した上で、JME送金サービスの利用を依頼します。 I understand and agree to the ”Terms and Conditions for Overseas Remittance” of Japan Money Express Co., Ltd. (JME). I confirm that this remittance has nothing to do with North Korea or Iran. Also, I have no relation to any Anti-Social Forces or any engagement in illegal activities. I am not Politically Exposed Persons(PEPs). I confirm the information shown in this application to avail the remittance service is true and correct.

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Customer Signature

Date :