Luxoria Private Bank Account Opening Form
Please complete ALL fields before submission.
A. Account Requirement
Account Category
Sole
Joint
Currency Choice
EUR
USD
Account Type
-- Select Account Type --
International Personal Account
Private Banking Account
Premier Wealth Account
Entrepreneur & Business Owner Account
Corporate Banking Account
Referral Identification Number (RIN)
B. Personal Details
Full Name
Passport Number
Gender
Select
Male
Female
Date of Birth
Nationality
Country of Residence
Mailing Address
Residential Address
Mobile Number
Email Address
C. Employment Details
Occupation
Company/Employer
Nature of Business
Monthly Gross Income
Currency
EUR
USD
Yearly Gross Income
Currency
EUR
USD
D. Documents Required
Upload Proof of Address
Upload Proof of Identification
Upload ID Confirmation Photo
E. Additional Details
Home Ownership
Select
Owned
Rented
Mortgaged
Employer's
Marital Status
Select
Single
Married
Widowed
Divorced/Separated
Spouse Name
F. Account Opening Information
Purpose of Account Opening
Source of Funds
Preferred Deposit Method
Select
Bank Transfer
Money Transfer Company
Cryptocurrency
PayPal
G. Online Banking Security Setup
Create Online Banking Username/ID
Create Online Banking Password
Secret Question
-- Select a Secret Question --
What was the name of your first pet?
What is your mother's maiden name?
What was the name of your first school?
In what city were you born?
What is your favorite book?
What was the make of your first car?
What is the name of your childhood best friend?
What was your dream job as a child?
What is your favorite holiday destination?
What is the name of the street you grew up on?
Secret Answer
H. Customer Declaration
I/We declare that the information provided above is true and correct. I/We authorize the Bank to verify the information submitted.
Initials
Date
Submit Application
