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Your company
US Beneficial Ownership Certification Form
Private company · Standard · US BSA / FinCEN

1. Organisation details

Registered legal name*1020.220(a)(2)(i)
Legal form*
Private limited companyPublic limited companyLimited liability partnershipGeneral or limited partnershipFoundationAssociation or societyCooperativeBranch of a foreign companyOther
Registration number and name of the register*
Country of incorporation or registration*
Select a country ▾
Registered office address*

2. Management and authority

Senior managing official (CEO, managing director or equivalent)*1010.230(d)(2)
Person completing this form for the customer: full name, role and date of birth*

3. Beneficial owners

Does any person own or control 25% or more of the organisation, directly or through other companies?*1010.230(d)(1)
YesNo
For each beneficial owner: full name, date and place of birth, nationality, residential address, percentage held and whether held directly or indirectly*1010.230(b)(1)
Identity documents of the beneficial owners1010.230(b)(2)
Upload a file (PDF, JPG or PNG)

4. Declaration and signature

I confirm the information in this form is true and complete, and I will tell you promptly if it changes.*
I agree
Name, position and signature*
Date*
DD / MM / YYYY

About this template

A beneficial ownership certification for legal entity customers under the FinCEN CDD rule. It names every owner of 25% or more and one person with significant control.

When to use it

Use it when a US financial institution opens an account for a company.

What it covers

This is a focused form. It collects only what this declaration needs. For full onboarding, pair it with a complete KYC or KYB form.

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.

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