Illustrative Customer Due Diligence Templates Page 13
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25EP 200 IG 2
FORM C
(Agents)
Form C: Individuals with Executive Authority/Agents
Where a person purports to act on behalf of a client, the professional firm shall identify and verify the
identity of the person and shall verify that the person is so authorised by completing this form.
Identification
FOR AGENTS WHO ARE INDIVIDUALS ONLY
Full legal name(s),
Unique
both official and any
identification
aliases:
number:
Contact number(s):
Occupation:
Nationality:
Date of birth:
Residential street
address:
Address of principal
place of business (if
different from above):
FOR AGENTS WHO ARE LEGAL PERSONS
Full legal name of
Incorporation
registration:
number or
registration
number:
Contact number(s):
Place of incorporation
or registration:
Date of incorporation
or registration:
Registered address:
Address of principal
place of business (if
different from above):
*If the agent is a PEP, Form D must be completed in addition to this form.
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