Illustrative Customer Due Diligence Templates (Page 16 of 25) in pdf

Illustrative Customer Due Diligence Templates Page 16

EP 200 IG 2

FORM D

(PEP)

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:

○

Verification (for office use)

Documents required for verification

☐

Copy of screening results from a reliable independent database (e.g., Thomson Reuters World-

Check, Dow Jones Risk and Compliance database) of the PEP

☐

A document containing the address of the PEP (e.g., a bank statement or a recent utility bill)

☐

Documents verifying the source of funds and wealth

☐

Copy of passport or identification card (for Singaporeans only)

☐

Any published convictions, penalties and sanctions involving the PEP

Examples of independent verification measures include citing public information sources (e.g. company websites, corporate

registration websites, journals and media reports) to verify net worth as well as obtaining documentary evidence, such as bank

statements, confirmation from third party professionals (e.g. tax advisors), and financial statements or management accounts of

operating companies. Professional firms should also assess the authenticity and reliability of the documents provided by the

clients. More evidentiary verification options are typically required for higher-risk clients. Aside from the common verification

measures such as citing public information sources, some institutions commission independent investigations to perform

background checks on higher-risk PEPs, obtain financial statements of the business(es) where the source of wealth/funds is

derived, and perform site visits.

Illustrative Customer Due Diligence Templates Page 16