Information to Be Obtained from Client

Information to be Obtained from Client

Information collected in this form should be verified. Verification can be done subsequent to completing risk assessment.

Identification

FOR NATURAL PERSONS/SOLE PROPRIETORSHIPS ONLY
Full legal name(s), both official and any aliases: / Unique identification number:
Contact number(s):
Nationality:
Date of birth:
Residential street address:
Address of principal place of business (if different from above):
Intended nature and purpose of the business relationship:
Name of beneficial owner(s): / (Please complete Form A for each beneficial owner.)
Name of person(s) with executive authority: / (Please complete Form C for each person with executive authority.)

Additional information required

Question / Response
Are you, or any party connected to you, a politically exposed person? / Yes
(Please complete Form D for each PEP) / No
What country is your business based in?
What type of products does your business sell or manufacture? Please provide further details in the box below if necessary.
Any further details:

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)

Professional judgment must be exercised in determining if verification of identity should be that of “Normal CDD” or “Enhanced CDD” standards, depending on the risk assessment performed on the client.

For Normal CDD, the following documents can be used to verify the client’s identity:

Copy of screening results from a reliable independent database (e.g., Thomson Reuters World-Check, Dow Jones Risk and Compliance database) of the client / ☐
Copy of passport or identification card (for Singaporeans and Singaporean Permanent Residents only) / ☐
A document containing the address of the individual (e.g., a bank statement or a recent utility bill) / ☐

Information to be Obtained from the Client

Identification

FOR LEGAL PERSONS ONLY
Full legal name of registration:
Contact number(s):
Business type: / Partnership / Limited Liability Partnership / Corporation*
Other:
*delete where inapplicable
Registration number/incorporation number: / Country of incorporation or registration:
Registered address:
Address of principal place of business (if different from above):
Intended nature and purpose of the business relationship:
Names of the directors or partners:
Name of beneficial owner(s): / (Please complete Form A for each beneficial owner. Where a beneficial owner cannot be identified, please complete Form B instead.)
Name of person(s) with executive authority: / (Please complete Form C for each person with executive authority.)

Additional information required

Client/Agent’s Declaration

Name of client/agent:
Identity/passport number:
Date:
Signature:

○ Verification (for office use)

For Normal CDD, the following documents can be used to verify the client’s identity:

Copy of screening results from a reliable independent database (e.g., Thomson Reuters World-Check, Dow Jones Risk and Compliance database) of the client / ☐
Memorandum and Articles of Association / ☐
ACRA profile of the company or incorporation or registration documents from a regulatory body (for foreign firms) or certificate of incorporation (for foreign firms) / ☐
Information documenting the ownership and control structure of the entity (e.g., ownership chart signed by a director.) / ☐

Form A: Beneficial Owners

For each beneficial owner that the client has, please complete the following form. Certain clients do not need to fill up this form. Please refer to Annex 1 for a list of these clients.

If an ACRA search profile of the shareholders have been obtained, it is not necessary to verify the identity of the shareholders/partners further. A shareholder may be a beneficial owner if the shareholder ultimately owns or controls more than 25% of shares in the company.

Identification

BENEFICIAL OWNER
Full legal name(s), both official and any aliases: / Unique identification number:
Contact number(s):
Occupation:
Nationality:
Date of birth:
Residential street address:
Information regarding the nature of beneficial ownership and the ownership and control structure of the client:

*If the beneficial owner is a PEP, Form D must be completed in addition to this form.

Client/Agent’s Declaration

Name of client/agent:
Identity/passport number:
Date:
Signature:

○ Verification (for office use)

Verification of the identity of beneficial owners is to be done on the basis of risk. Reasonable measures should be taken to verify the identity of the beneficial owners. For example, the following documents can be collected:

Copy of screening results from a reliable independent database (e.g., Thomson Reuters World-Check, Dow Jones Risk and Compliance database) of the beneficial owner / ☐
Copy of passport or identification card (for Singaporeans and Singaporean Permanent Residents only) / ☐

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), both official and any aliases: / Unique identification 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

Name of client/agent:
Identity/passport number:
Date:
Signature:

○ Verification (for office use)

Verification of the identities of senior managing officials is to be done on the basis of risk. Reasonable measures should be taken to verify the identity of the beneficial owners. For example, the following documents can be collected:

Copy of screening results from a reliable independent database (e.g., Thomson Reuters World-Check, Dow Jones Risk and Compliance database) of the senior managing official / ☐
Copy of passport or identification card (for Singaporeans and Singaporean Permanent Residents only) / ☐

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), both official and any aliases: / Unique identification 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 registration: / Incorporation 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.

Client/Agent’s Declaration

Name of client/agent:
Identity/passport number:
Date:
Signature:

○ Verification (for office use)

The authority of an agent to act on behalf of the client shall be verified. This may be done by obtaining documentary evidence that the client has appointed the agent to act on his behalf or a summary of the oral instructions given to the agent by the client; and the specimen signatures of the person appointed.

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 entrusted with[1]:
Name of public function:
Country:
Period of service:
PEP relationship with the client: / Self
Family member (Spouse / Child / Parent / Child’s Spouse*)
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:

Client/Agent’s Declaration

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[2] / ☐
Copy of passport or identification card (for Singaporeans only) / ☐
Any published convictions, penalties and sanctions involving the PEP / ☐

Anti-Money Laundering / Countering the Financing of Terrorism (AML/CFT)

Risk Assessment Form

For existing clients only (leave this field blank if not applicable): / Response
Routine review of existing client / Yes / No
Review as a result of a trigger event – Please indicate the trigger event: / Yes / No
For new clients only (leave this field blank if not applicable): / Response
Referred client – Please indicate source of referral below: / Yes / No

Please provide details regarding the nature of services required by client[3]:

Establishing or continuing business relationship with the client is NOT allowed if the answer to any of the questions below is "NO."

Question / Response
For new client, up-to-date and relevant client identification information, including information on shareholders and directors, has been obtained as per Page 1. / Yes / No / N/A
For existing client, no doubt arises as to the veracity or adequacy of the evidence previously obtained for the purposes of client identification; otherwise, client identification information has been re-verified. / Yes / No / N/A
Client and connected parties[4] DO NOT MATCH with terrorist suspects and/or special interest entities in reliable, independent screening databases[5]. / Yes / No
Client and connected parties DO NOT MATCH with any of the names under the list of names under the applicable Schedules of the Terrorism (Suppression of Financing) Act (Cap. 325) and United Nations sanctioned entities. / Yes / No

If the answer to any of the following questions is "Yes”, the business relationship must be either terminated or declined. If the answer is “No”, the risk level is “Normal” and you may proceed to the risk assessment questionnaire.

Question / Response
The ownership of the client is unable to be verified (i.e. comparing information based on documents). / Yes / No

Risk Assessment Questionnaire

Section 1: Client background

Question / Response
Client or beneficial owners[6] or directors is a Politically Exposed Person (PEP). / Yes / No
Client or beneficial owner or directors is matched with a person in the MAS control list.
The issues are related to predicate crimes for money laundering and/or fraud and/or crime (including suspected cases). / Yes
Yes / No
No
Client or beneficial owner or connected party has adverse news based on searches from Factiva and/or Google.
The issues are related to predicate crimes for money laundering and/or fraud and/or crime (including suspected cases). / Yes
Yes / No
No
Client is involved in High-Risk Industry[7]. / Yes / No
Client has nominee shareholder/s in the ownership chain where there is no legitimate rationale.
The nominee shareholder/s represent/s majority ownership / Yes
Yes / No
No
Client is:
- a shell company or has complex shareholding structure (e.g., involving 3 layers or more of ownership structure, different jurisdictions, trusts); AND
- without an obvious commercial purpose. / Yes / No
Client is a charitable or non-profit organization that is NOT registered in Singapore (charities.gov.sg/charity/index.do). / Yes / No

Section 2: Client Location