APPLEBY TRUST (ISLE OF MAN) 
KYC Review Form IOM (IN) Individual

 

 

 

 

 

 

Client Name Rustic Hill Advisors inc 
Position 3 Beneficial Owner ..
Name Warren Amerine Stephens .
Address _United States

 

 

Date of Birth 

How has the identity of this individual been verified?

Passport 
Date from: 6-Nov-2008 - to: 5-Nov?201 6 i

Certified US passport number- certified by Jackson Farrow Jr. General Counsel of
Stephens Capital Partners LLC.

How has the address of this individual been veri?ed? 3
Date from: 13-Dec-2011 - to: 13-Dec-2011 . 
gem Jaws/l .

Copy electricity bill provided.

 

What is the Owner of Stephens Capital Partners LLC. 
nature of this 14}th 
individual?s 
source of income, 
wealth or

employment?

 

 

 

 

 

Source of Funds

   

 

 

 

 

 

 

 

 

 

 

 

 

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Risk Profile 
World Check Passport World check and passport checked on 16th January 2012, all 
Check clear.
Reference Reference provided by Jackson Farrow Jr. General Counsel of 
Stephens Capital Partners LLC. 5
Verification of Certifier See e-mail from Arkansas Bar Association.
Any further Background
information 
Signed 6 ?l 
Name owns Lama . Skit/Lucas).

 

 

Date . - 

?massif?r?s sign-off ?Compliance sign be"
61912?? <2on {haggard ~C/leAreJ 

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