APPLICATION FORM TO OPEN A SWISS BANK ACCOUNT
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    Micheloud & Cie
    Grand-Chene 8
    CH-1003 Lausanne
    Switzerland
    Tel ++41 21 331 48 48
    Fax ++41 21 331 48 40 
    info@swiss-bank-accounts.com
    http://www.swiss-bank-accounts.com			     
 							     
 							     
  Please do not hesitate to call  or  email if you need any  
  assistance in filling this form.

  Micheloud & Cie offers services to open accounts with Swiss
  banks. We are not a bank and do  not  accept  nor  sollicit
  deposits. The set-up fee remunerates our  services  and  is 
  due when we start the procedure. It will be fully  refunded 
  if the bank turns down your application,  but  not  if  you 
  decide to cancel your order.  
 							     
  Complete information about our banking products and the    
  latest version of this form can be found on our website    
  at http://www.swiss-bank-accounts.com	     
 							     
      *  indicates mandatory questions
     (x) tick box to indicate a positive answer	     
	     
 							     
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 A. PERSONAL INFORMATION
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      *	FIRST NAME		:

      *	LAST (FAMILY) NAME	:

      *	CITIZENSHIP 		:

	SECOND CITIZENSHIP 	:  

      *	COUNTRY OF RESIDENCE	:

      *	SEX			:

      *	OCCUPATION		:

      *	MARITAL STATUS		:

      *	DATE OF BIRTH
		Day		:
		Month		:
		Year		:  

	ANNUAL INCOME
		Income		:
		Currency	:



 B. BANKING NEEDS
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      *	TYPE OF ACCOUNT		:
        ( ) Classic Swiss bank account    CHF 899.-
        ( ) Premium Swiss bank account    CHF 1199.-
        ( ) Swiss cantonal bank account   CHF 1199.-
        ( ) Swiss numbered account        CHF 1299.-

         Our prices are in  Swiss  francs (CHF).  Prices  and 
         offers can change at any time. For the latest prices
         and account descriptions contact  us  or  visit  our 
         website http://www.swiss-bank-accounts.com.


      * WHEN WILL YOU MAKE YOUR FIRST DEPOSIT AND HOW
        MUCH WILL YOU DEPOSIT?


      *	WHAT IS THE AVERAGE ACCOUNT BALANCE YOU INTEND TO
        MAINTAIN ON THIS ACCOUNT?
		Amount		:
		Currency	:


      *	IN WHICH CURRENCY DO YOU WANT YOUR ACCOUNT?
	(You can write several currencies if you 
	 want a multiple currency account)


      *	WHAT IS THE ECONOMIC ORIGIN OF THE MONEY?




	(This information, as the rest of the form, will be
	 kept strictly confidential. We  need it to satisfy 
	 our due diligence  requirements. We cannot open an 
	 account if we don't know precisely where the money 
	 comes from.)


      *	WHY DO YOU WANT TO OPEN THIS ACCOUNT?



      * HOW DO YOU PLAN TO USE THIS ACCOUNT?



      *	IN WHICH LANGUAGE DO YOU WISH TO COMMUNICATE
        WITH THE BANK?
               Bank documents : 
                  ( ) English
                  ( ) French
                  ( ) German
                  ( ) Italian

                Account officer : 
                  ( ) English
                  ( ) French
                  ( ) German
                  ( ) Italian



 C. CONTACT INFORMATION
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	SPECIAL INSTRUCTIONS WHEN CONTACTING YOU :



	EMAIL ADDRESS		:

	PHONE NUMBERS
		Home		:
		Work		:
		Mobile		:

	FAX NUMBER		:


We need several addresses to process your application  (up to
3). Some people use only one address, some  put  3  different
addresses. The first one, the "Legal Address", will  be  used
to write bank contracts. The "Address for opening documents",
is where Micheloud & Cie will send you the documents you have
to sign to open the account. Finally, "Address for bank mail",
is used by the bank to send you bank statements.

      * LEGAL ADDRESS
		Street 		:
		City		:
		ZIP code	:
		Country		:

      * ADDRESS FOR OPENING DOCUMENTS
		Send to legal address ( )
		Street 		:
		City		:
		ZIP code	:
		Country		:

      * ADDRESS FOR BANK MAIL
		Send to legal address 			( )
		Keep at bank until further instructions ( )
		Send the the address below 		( )
		  Adressee 	:
		  Street 	:
		  City		:
		  ZIP code	:
		Country		:





 C. PAYMENT INFORMATION
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	You can  pay our  account  opening  fee  by  Visa, 
	Mastercard, bank transfer or Western Union. 

      * PAYMENT METHOD
		Bank transfer ........................... ( )
		Western Union ........................... ( )
		Credit card ............................. ( )
		  Name on card	   :
		  Card number	   :
		  Expiration date  :
		  Card type	   :
                         Visa ........................... ( )
                         Mastercard ..................... ( )
                         American Express ............... ( )
		  CVV2 code        : 
                  (3 digits code at the back of  your  card
                   we need only the last 3 digits if longer)

        By filling this box I authorize Micheloud & Cie to
        charge my credit card for the  account set-up  fee
        as well as courier charges if applicable.

	For more payment information refer to: 
        http://swiss-bank-accounts.com/




 D. COMPLEMENTARY INFORMATION
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	SEND ME THE OPENING DOCUMENTS BY COURIER ........ ( )
	(We charge the cost of the courier extra - it usually 
	 costs around 30$ for  most  countries.  It  normally 
	 arrives in 2-3 days)


      * I READ AND ACCEPTED YOUR CONDITIONS ............. ( )
	www.swiss-bank-accounts.com//e/banking/conditions.html

      * I UNDERSTANT THERE WILL BE NO REFUND IF I DECIDE TO 
        CANCEL MY APPLICATION ............. ............. ( )

      * I FILLED THIS QUESTIONNAIRE HONESTLY ............ ( )

      * MICHELOUD & CIE DID NOT ENCOURAGE ME TO BREAK
	ANY LAW ......................................... ( )

      * HOW DID YOU LEARN ABOUT US ?

      * DATE

      * YOUR SIGNATURE



 ------------------------------------------------------------
 |  When filled, please send to : 			    |
 |							    |
 |	Micheloud & Cie					    |
 |	Grand-Chene 8					    |
 |	CP 3332						    |
 |	CH-1002 LAUSANNE				    |
 |	SWITZERLAND					    |
 |							    |
 |	Fax 	: + 41 (0) 21 331 48 40			    |
 | 	Phone	: + 41 (0) 21 331 48 48 		    |
 |	Email	: info@swiss-bank-accounts.com              |
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  © Micheloud & Cie 2003