Declarations
PEP Declaration Form
A short declaration where a customer confirms whether they, a family member or a close associate hold a prominent public function, with the source of funds and wealth that follows.
12 questionsEU AMLR
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High-Risk Country Customer Questionnaire
Individual · Enhanced · High-risk country link · EU AMLR
1. Personal details
Full legal name (all first names and surnames)*Art 22(1)(a)(i)
Other names you have used (former names, aliases)
Date of birth*Art 22(1)(a)(ii)
DD / MM / YYYY
Place of birth (city and country)*Art 22(1)(a)(ii)
Nationality (list every nationality you hold)*Art 22(1)(a)(iii)
National identification number or passport number, with issuing country*Art 22(1)(a)(iii)
Residential address*Art 22(1)(a)(iv)
Country of residence*Art 22(1)(a)(iv)
Select a country ▾
Copy of your passport or national identity card (front and back)*Art 22(6)
Upload passport or national ID card, front and back
Email address*
Phone number
2. Management and authority
Person completing this form for the customer: full name, role and date of birth*Art 20(1)(i)
Proof of authority (power of attorney or board resolution), if acting for someone elseArt 20(1)(i)
Upload a file (PDF, JPG or PNG)
3. Occupation and business
Employment status*Art 20(1)(e), 25(e)
EmployedSelf-employedBusiness ownerRetiredStudentNot workingOther
Occupation, employer or business name, and sectorArt 25(e)
4. Purpose and expected activity
Why do you want to open this relationship, and what will you use it for?*Art 20(1)(c), 25(a)
Which products or services will you use?*Art 25(a)
Current or business accountDomestic paymentsInternational paymentsCurrency exchangeCardsLendingSavings or investmentsCrypto-assetsOther
Expected value of transactions per month (EUR or equivalent)*Art 25(b)
Under 10,00010,000 to 50,00050,000 to 250,000250,000 to 1,000,000Over 1,000,000
Expected number of transactions per monthArt 25(b)
Under 1010 to 5050 to 250Over 250
Main countries you will send money to or receive it from*Art 25(d)
Will you carry out transactions on behalf of, or for the benefit of, anyone else?*Art 20(1)(h)
No, only for myself or this organisationYes, explain below
Do you expect any large or one-off transactions? Describe them and why.*Art 34(4)(d)
5. Source of funds and wealth
Where will the money for this relationship come from?*Art 25(c)
Salary or pensionBusiness incomeSavingsInvestmentsSale of property or assetsInheritance or giftLoanDonations or grantsOther
Bank and country of the account the funds will come from
How was your overall wealth built up? (source of wealth)*Art 34(4)(c), 42
Evidence of source of funds and wealth (for example payslips, sale contract, audited accounts)*Art 34(4)(c)
Upload a file (PDF, JPG or PNG)
Approximate total net worth (EUR or equivalent)Art 34(4)(a)
Under 100,000100,000 to 1 million1 to 5 millionOver 5 million
Will your first payment come from an account in your own name at a bank that applies customer due diligence?*Art 34(4)(g)
YesNo
6. High-risk countries
Describe your links to the high-risk country (residence, ownership, business, transactions)*Art 29
Why do you need to do business with or through this country?*Art 34(4)(d)
7. Politically exposed persons
Do you, or does any beneficial owner, director or authorised signatory, hold a prominent public function now or in the last 12 months?*Art 20(1)(g), 42, 45
NoYes, give details below
Is any of them a family member or known close associate of such a person?*Art 46
NoYes, give details below
If yes: name, position, country and dates in officeArt 42
8. Sanctions and other declarations
Are you, or is any beneficial owner, director or related company, named on a sanctions list (UN, EU, UK or US)?*Art 20(1)(d)
NoYes, explain below
Do you do business in, with, or through comprehensively sanctioned countries or regions?*
NoYes, explain below
Has the customer, any owner or any director been convicted of, or investigated for, a financial crime?*Art 34(4)(a)
NoYes, explain below
9. Tax residency
Countries of tax residence
Tax identification numberArt 22(1)(a)(iv), (b)(iii)
Are you a US person for tax purposes?
NoYes
10. Documents to provide
Proof of address dated in the last 3 months (utility bill or bank statement)
Upload a file (PDF, JPG or PNG)
11. Declaration and signature
I confirm the information in this form is true and complete, and I will tell you promptly if it changes.*Art 26
I agree
I understand my information will be used to meet anti-money laundering obligations and kept for at least 5 years after the relationship ends.*Art 77
I agree
Name, position and signature*
Date*
DD / MM / YYYY
12. For internal use
Screening: sanctions, PEP and adverse media for the customer, beneficial owners and directors (date and result)*Art 20(1)(d), (g)
Customer risk rating and reason*
LowMediumHigh
Senior management approval (name and date)*Art 34(4)(e), 42(1)(a)
Next review date*Art 26(2)
DD / MM / YYYY
Reviewed by (name and date)*
About this template
An enhanced due diligence form for customers linked to a high-risk third country. It asks how they are linked to the country, why they need to do business there and where their money comes from.
When to use it
Use it when the customer, an owner or a transaction is linked to a country on the EU or FATF high-risk list.
Core requirements covered
9 of 9 core requirements of EU AMLR.
- Identify and verify the customer✓
- Verify identity from a document or eID✓
- Purpose and intended nature✓
- Targeted financial sanctions✓
- Nature of the customer's business✓
- Ongoing monitoring✓
- Politically exposed persons✓
- On behalf of someone else✓
- Authority of the person acting✓
Edit it before you use it
Every question can be removed, reworded, reordered or made optional in the editor. You can add your own questions and fields too.
| Question | Field type | Section | Legal basis |
|---|---|---|---|
| Full legal name (all first names and surnames) * | Text | Personal details | Art 22(1)(a)(i) |
| Other names you have used (former names, aliases) | Text | Personal details | Good practice |
| Date of birth * | Date | Personal details | Art 22(1)(a)(ii) |
| Place of birth (city and country) * | Text | Personal details | Art 22(1)(a)(ii) |
| Nationality (list every nationality you hold) * | Text | Personal details | Art 22(1)(a)(iii) |
| National identification number or passport number, with issuing country * | Text | Personal details | Art 22(1)(a)(iii) |
| Residential address * | Long text | Personal details | Art 22(1)(a)(iv) |
| Country of residence * | Country | Personal details | Art 22(1)(a)(iv) |
| Copy of your passport or national identity card (front and back) * | ID document | Personal details | Art 22(6) |
| Email address * | Personal details | Good practice | |
| Phone number | Phone | Personal details | Good practice |
| Person completing this form for the customer: full name, role and date of birth * | Long text | Management and authority | Art 20(1)(i) |
| Proof of authority (power of attorney or board resolution), if acting for someone else | File upload | Management and authority | Art 20(1)(i) |
| Employment status * | Single choice | Occupation and business | Art 20(1)(e), 25(e) |
| Occupation, employer or business name, and sector | Text | Occupation and business | Art 25(e) |
| Why do you want to open this relationship, and what will you use it for? * | Long text | Purpose and expected activity | Art 20(1)(c), 25(a) |
| Which products or services will you use? * | Multiple choice | Purpose and expected activity | Art 25(a) |
| Expected value of transactions per month (EUR or equivalent) * | Single choice | Purpose and expected activity | Art 25(b) |
| Expected number of transactions per month | Single choice | Purpose and expected activity | Art 25(b) |
| Main countries you will send money to or receive it from * | Long text | Purpose and expected activity | Art 25(d) |
| Will you carry out transactions on behalf of, or for the benefit of, anyone else? * | Single choice | Purpose and expected activity | Art 20(1)(h) |
| Do you expect any large or one-off transactions? Describe them and why. * | Long text | Purpose and expected activity | Art 34(4)(d) |
| Where will the money for this relationship come from? * | Multiple choice | Source of funds and wealth | Art 25(c) |
| Bank and country of the account the funds will come from | Text | Source of funds and wealth | Good practice |
| How was your overall wealth built up? (source of wealth) * | Long text | Source of funds and wealth | Art 34(4)(c), 42 |
| Evidence of source of funds and wealth (for example payslips, sale contract, audited accounts) * | File upload | Source of funds and wealth | Art 34(4)(c) |
| Approximate total net worth (EUR or equivalent) | Single choice | Source of funds and wealth | Art 34(4)(a) |
| Will your first payment come from an account in your own name at a bank that applies customer due diligence? * | Single choice | Source of funds and wealth | Art 34(4)(g) |
| Describe your links to the high-risk country (residence, ownership, business, transactions) * | Long text | High-risk countries | Art 29 |
| Why do you need to do business with or through this country? * | Long text | High-risk countries | Art 34(4)(d) |
| Do you, or does any beneficial owner, director or authorised signatory, hold a prominent public function now or in the last 12 months? * | Single choice | Politically exposed persons | Art 20(1)(g), 42, 45 |
| Is any of them a family member or known close associate of such a person? * | Single choice | Politically exposed persons | Art 46 |
| If yes: name, position, country and dates in office | Long text | Politically exposed persons | Art 42 |
| Are you, or is any beneficial owner, director or related company, named on a sanctions list (UN, EU, UK or US)? * | Single choice | Sanctions and other declarations | Art 20(1)(d) |
| Do you do business in, with, or through comprehensively sanctioned countries or regions? * | Single choice | Sanctions and other declarations | Good practice |
| Has the customer, any owner or any director been convicted of, or investigated for, a financial crime? * | Single choice | Sanctions and other declarations | Art 34(4)(a) |
| Countries of tax residence | Text | Tax residency | Good practice |
| Tax identification number | Text | Tax residency | Art 22(1)(a)(iv), (b)(iii) |
| Are you a US person for tax purposes? | Single choice | Tax residency | Good practice |
| Proof of address dated in the last 3 months (utility bill or bank statement) | File upload | Documents to provide | Good practice |
| I confirm the information in this form is true and complete, and I will tell you promptly if it changes. * | Checkbox | Declaration and signature | Art 26 |
| I understand my information will be used to meet anti-money laundering obligations and kept for at least 5 years after the relationship ends. * | Checkbox | Declaration and signature | Art 77 |
| Name, position and signature * | Text | Declaration and signature | Good practice |
| Date * | Date | Declaration and signature | Good practice |
| Screening: sanctions, PEP and adverse media for the customer, beneficial owners and directors (date and result) * | Long text | For internal use | Art 20(1)(d), (g) |
| Customer risk rating and reason * | Single choice | For internal use | Good practice |
| Senior management approval (name and date) * | Text | For internal use | Art 34(4)(e), 42(1)(a) |
| Next review date * | Date | For internal use | Art 26(2) |
| Reviewed by (name and date) * | Text | For internal use | Good practice |
Which countries are high risk?
Countries on the EU high-risk third country list or the FATF lists. Check a country in the free Country Risk Index.
Is enhanced due diligence mandatory?
Yes. EU rules require it for relationships involving high-risk third countries.
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