Illustrative Customer Due Diligence Templates Page 15
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25EP 200 IG 2
FORM D
(PEP)
Form D: Politically Exposed Persons (PEPs)
Where there is one or more PEPs involved, this form must be completed. Please use a separate form for
each PEP.
Identification
FOR POLITICALLY EXPOSED PERSON(S) ONLY:
Name of PEP:
Nature of prominent
public function that the
PEP is or has been
1
entrusted with
:
Name of public
function:
Country:
Period of service:
PEP relationship with
Self
Family member (Spouse / Child / Parent / Child’s Spouse*)
the client:
Close associate
Ultimate beneficial owner / shareholder / director / partner / authorized
person* of client
Others (please specify):
*delete where inapplicable
Source(s) of wealth:
Approximate Amount (SGD)
Select where appropriate
Net Worth
Annual
Income
Operating income
From shareholders
From group companies
Investment
Credit facilities
Others (please specify):
Source of funds:
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For example, as a domestic politically exposed person, a foreign politically exposed person, or a politically exposed person of an
international organisation.
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