Confirmation of Verification of Identity

CONFIRMATION OF VERIFICATION OF IDENTITY

PRIVATE INDIVIDUAL

INTRODUCTION BY AN FSA-REGULATED FIRM

1)DETAILS OF INDIVIDUAL (See explanatory notes below)

Full name of customer:
Current Address: / Previous address if individual has changed address
in the last three months
Date of Birth:

2)CONFIRMATION

I/we confirm that

(a)the information in section 1 above was obtained by me/us in relation to the customer;

(b)the evidence I/we have obtained to verify the identity of the customer:

[tick only one]

Meets the standard evidence set out within the guidance for the UK Financial Sector issued by JMLSG; or
Exceeds the standard evidence (written details of the further verification evidence taken are attached to this confirmation)
Signed:
Name:
Position:
Date:

3)DETAILS OF INTRODUCING FIRM (OR SOLE TRADER)

Full Name of Regulated Firm (or Sole Trader): / Professional Independent Advisers Ltd
FSA Reference Number: / 125921

EXPLANATORY NOTES

1)A separate confirmation must be completed for each customer (e.g. joint holders, trustee cases and joint life cases). Where a third party is involved, e.g. a payer of contributions who is different from the customer, the identity of that person must also be verified and a confirmation provided.

2)This form cannot be used to verify the identity of any customer that falls into one of the following categories:

those who are exempt from verification as being an existing client of the introducing firm prior to the introduction of the requirement for such verification;

those whose identity has not been verified by virtue of the application of a permitted exemption under the Money Laundering Regulations; or

those whose identity has been verified using the source of funds as evidence.

3)This confirmation must carry an original signature, or an electronic equivalent.

Evidence of Name
(List A) / Reference/account
Number / Certified copy
Attached? (2)
Current Signed Passport or
EEA Member STATE
IDENTITY CARD / Place
of Birth / Date
of Birth / Date
of expiry
Resident Permit issued to EEA Nationals by Home Office / Date
of expiry
Current UK/EEA Photo
Driving Licence (1) / Date
of issue
Current Full UK Driving
Licence (old style) (1) / Date
of issue
Firearms certificate / Issuing
Authority / Date
of Issue
State Pension or Benefits
Book/notification letter (1) / Issuing
Authority / Date
of Issue
Sub-contractors Certificate (3) / Issuing
Authority / Date
of Issue
Inland Revenue tax
Notification / Type: P45/P60/Notice of Coding (4)
Evidence of Address
(List B) / Reference/account
number / Certified copy
attached? (2)
Home Visit / Premises entered?
Y/N / Date
of visit
Solicitor letter confirming completion of house purchase or land registration (5) (6) / Date
of letter
Electoral roll check (5) / Date
of check
Most Recent Mortgage Statement / Name of Lender / Address current
Y/N / Date
of issue
Current Local Authority Tax
Bill / Name of Authority / Address current
Y/N / Date
of issue
Local Authority rent card or tenancy agreement / Name of Authority / Address current
Y/N / Date
of issue
Bank/building society/credit union statement or passbook / Name of Issuer / Address current
Y/N / Date
of issue
Utility Bill (not mobile phone) / Name of Utility / Address current
Y/N / Date
of issue
Current UK/EEA Photo
Driving Licence (1) / Address current
Y/N / Date
of issue
Current Full UK Driving Licence (old style) (1) / Address current
Y/N / Date
of issue
State Pension or Benefits Book/notification letter (1) / Issuing Authority / Address current
Y/N / Date
of issue
House or Motor Insurance
Certificate / Name of issuer / Address current
Y/N / Date
of issue
Notes
(1) / These items may be used to evidence address or identity but not both.
(2) / If attaching certified copies of the evidence please also record the relevant details on this sheet as this will help with record keeping in the event that copy documents become detached from the certificate.
(3) / For self-employed persons in the construction industry – tax exemption certificate with photograph.
(4) / Please delete as appropriate
(5) / You must submit a certified copy of the search if you are relying on this as evidence.
(6) / The previous address should also be verified.
Other forms of evidence may be accepted by some providers; if in doubt, please enquire.