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Kyc Form

This document provides a form for collecting know your customer (KYC) information annually. It requests identification details, address, contact information, and banking details for individuals. For non-individuals, it requests corporate details, a contact person, banking details, declaration of beneficial ownership, and required anti-money laundering documents. The form is to be completed, signed, and dated to update KYC information on an annual basis.

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Kealeboga Elliott Kealeboga
Copyright
© © All Rights Reserved
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Download as DOCX, PDF, TXT or read online on Scribd
313 views

Kyc Form

This document provides a form for collecting know your customer (KYC) information annually. It requests identification details, address, contact information, and banking details for individuals. For non-individuals, it requests corporate details, a contact person, banking details, declaration of beneficial ownership, and required anti-money laundering documents. The form is to be completed, signed, and dated to update KYC information on an annual basis.

Uploaded by

Kealeboga Elliott Kealeboga
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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GUIDANCE FORM-MINIMUM REQUIREMENT- TO BE COMPLETED ANNUALLY 20___

KNOW YOUR CUSTOMER:

FORM LAST COMPLETED IN (MM/YR) ______________

FOR INDIVIDUALS

IDENTITY DETAILS:
Title________ Names(s) ___________________________ Surname_________________
Date of Birth_____________ National ID/Passport No ______________________________
Nationality __________________

ADDRESS AND CONTACT DETAILS:


Postal address _____________________________________________________________
Physical Address ___________________________________________________________
Village/Town/City_____________________ Country _______________________________
Duration of Stay ______if < 2 years give previous place of residence__________________
Telephone _______________ Mobile__________________ Fax______________________
Email Address ________________________________

For Proof of Address kindly submit any of the following valid documents (Latest):
Confirmation of Employment_________ Telephone Bill _________Electricity Bill_________
Water Bill ________ Affividaffit________

BANKING DETAILS
Bank Name _______________________________ Branch__________________________
Account Number ___________________________Account type______________________

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KYC FORM
GUIDANCE FORM-MINIMUM REQUIREMENT- TO BE COMPLETED ANNUALLY 20___

FOR NON-INDIVIDUALS
CORPORATE ENTITY:
Company Name _______________________________ Registration No _______________
Postal Address _____________________________________________________________
Physical Address___________________________________________________________
Email Address _____________________________________________________________
Country of Incorporation_____________________ Website ___________________
Brief description of business ____________________________________________
___________________________________________________________________

CONTACT PERSON
Title _________ Names(s) ______________________ Surname ___________________
Date of Birth______________ Nationality ID/Passport No _________________________
Nationality_______________ Capacity/Position_________________________________
Email Address_____________________ Telephone _____________Fax_____________
Physical Address______________________Village/Town/City___________________
Country _________________________

BANKING DETAILS
Bank_________________________________ Branch______________________________
Account Name________________________ Account no____________________________
Branch code______________

DECLARATION OF BENEFICIAL OWNERSHIP


The company hereby confirms and declares that as at the date hereof, the following
individual(s) is/are the ultimate principal beneficial owner(s) of the company through
ownership in the intermediate or ultimate holding companies:

Full Name Residential Date of Birth Nationality Percentage of


Address ownership

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KYC FORM
GUIDANCE FORM-MINIMUM REQUIREMENT- TO BE COMPLETED ANNUALLY 20___

ANTI-MONEY LAUNDERING AND COUNTER TERRORIST FINANCING


REQUIREMENTS
In accordance with the Financial Intelligence Regulations, the following documents should
be provided for verification:

Natural Persons
- Identification document eg Certified copy of ID/passport

Company
- Certificate of incorporation
- Memorandum of Articles of Association
- Notice of Registered Office and Postal Address
- Identification documents of the person(s) managing the company
- Resolution specifying who is authorised to act on behalf of the company
- Identification document(s) of the person(s) authorised to act on behalf of the
company.

Partnerships
- Partnership agreement
- Identification documents of the natural persons who are partners e.g certified copy of
I.D/ passport
- Resolution specifying who is authorised to act on behalf of the partnership
- Identification document(s) of the person(s) authorised to act on behalf of the
partnership

DECLARATION
I hereby declare that the details furnished above by myself are true and correct to the best of
my knowledge and belief. I shall inform you of any changes therein immediately. In case any
of the above information provided by myself is found to be false, misleading, or
misrepresenting I shall be liable for it.
Full Name________________________________________________________________
Designation/Position____________________ Date______________ Place _____________
Signature _______________________

Page 3 of 3
KYC FORM

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