Illustrative Customer Due Diligence Templates Page 11
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25EP 200 IG 2
FORM B
(For senior
managing officials)
Form B: Senior Managing Officials
In the event that no natural persons are identified as the beneficial owners, this form should be completed
to identify and verify the identity of the relevant natural person(s) holding the position of senior managing
official(s).
Identification
SENIOR MANAGING OFFICIAL 1
Full legal name(s),
Unique
both official and any
identification
aliases:
number:
Contact number(s):
Occupation:
Nationality:
Date of birth:
Residential street
address:
*If the senior managing offical is a PEP, Form D must be completed in addition to this form.
Client/Agent’s Declaration
I declare that the information provided in these forms is true and correct. I am aware that I may be subject
to prosecution and criminal sanctions under written law if I am found to have made any false statement
which I know to be false or which I do not believe to be true, or if I have intentionally suppressed any
material fact.
Name of client/agent:
Identity/passport number:
Date:
Signature:
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