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Aml Client Registration Form

The document is a client registration form for Khalid Alhassawi Auditing (KAA) that collects information about new clients such as entity details, ownership structure, authorized signatories, source of wealth and funds, and requires the client to confirm they are compliant with anti-money laundering regulations. The client must provide identification documents and answer questions verifying they are not involved in illegal activities, money laundering, terrorism or sanctions before being onboarded for services.

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kaaserver2023
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© © All Rights Reserved
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Download as PDF, TXT or read online on Scribd
138 views

Aml Client Registration Form

The document is a client registration form for Khalid Alhassawi Auditing (KAA) that collects information about new clients such as entity details, ownership structure, authorized signatories, source of wealth and funds, and requires the client to confirm they are compliant with anti-money laundering regulations. The client must provide identification documents and answer questions verifying they are not involved in illegal activities, money laundering, terrorism or sanctions before being onboarded for services.

Uploaded by

kaaserver2023
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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CLIENT REGISTRATION FORM

Khalid Alhassawi Auditing (KAA) (the Firm), customer due diligence requirements are determined
using a risk-based approach. We therefore may request additional information or documentation to
meet our regulatory obligations.

Please complete this checklist and submit to us.

Name of the client:


Type of the Entity (LTD, LLC, FZE/C
etc.):
Place of incorporation:
Date of Incorporation:

Registered Address:

License No.:

License Expiry Date:

Licensed Activities:

Tax Registration Number (TRN):


Telephone Number:
E-mail address:

Website:

Name and Email of contact person:

Name & Jurisdiction of Parent Company


(if any)
Services Required

Client Management Details


List of Shareholders
(Including both individual and corporate.
In case of corporate shareholder, kindly
provide the list of shareholders of the
corporate shareholder as requested in
the row below)

List of Shareholders (if Corporate


Shareholder) as specified above

Khalid Alhassawi Auditing (KAA)


Office No: 1011, Mazaya Shopping Centre, Sheikh Zayed Road - Dubai U.A.E.
Email: [email protected] Phone: (+971) 435-206-46
Voting rights percentage of the
Shareholders

List of Directors / Key Mgmt. Personnel


/Managers on license / Holder of POA
of shareholders

(Mention same as above if they are


sameas shareholders)

List of Beneficial Owners/UBO*


(Shareholders with 25% or
moreshareholding
rights. In case no UBO is defined,
people holding key management
positions in the Entity)

List of Authorized Signatories

(mention same as above if they


aresame as shareholders)

Source of wealth Please Source


Specify s
(Yes/ No)
Business Proceed
Employment
Inheritance
Gift/ Lottery
Fund from relatives
Shareholders’ fund
Others
If others,
please
mention
source

Source of funds Account Name:


(Please provide your firm bank Bank Name:
account details) Account Number:

Documents to verify identity & address of the Company.


1. A copy of valid commercial license
2. MOA or AOA or copy of latest amendments.
3. Proof of address (utility bill or tenancy contract)
4. Tax registration certificate (VAT)

Khalid Alhassawi Auditing (KAA)


Office No: 1011, Mazaya Shopping Centre, Sheikh Zayed Road - Dubai U.A.E.
Email: [email protected] Phone: (+971) 435-206-46
5. Ownership structure

Documents to verify identity of the Individuals.


1. Passport copies of authorized signatories, shareholders, directors

and beneficial owners.

2. Emirates ID or other valid identification document validated in

thecountry of residence.

*Kindly attach a copy of the original documents.

Please answer ALL questions below.

*Organization : Shall for the sake of brevity and convenience, deem to mean and include the firm, its shareholders,
directors, officers, or KMP and employees.

1. We confirm that our Organisation* has not received any communication, request, advise or notice
from law enforcement or regulatory authorities concerning non-compliance with the laws
and regulations of UAE.

Yes No

2. We confirm that our Organisation, has not received request or advice or notice from any
International Regulator relating to any Money Laundering, Terrorist Financing or Fraudulent
activity.

Yes No

3. We confirm that our Organisation has complied with all UAE Federal laws or regulations relating
to AML/CFT and has not committed any violations or possible violations of these laws and
regulations which may have any regulatory implications.

Yes No

4. We understand that our Organization is not involved in transferring or moving illegal


proceeds or conducting any transaction with the aim of concealing or disguising their illegal
source.

Yes No

5. We understand that our Organization does not have knowledge or is not involved in
concealing or disguising the true nature, source of location of any illegal proceeds as well as
methods involving their disposition, movement or ownership of rights.

Yes No

6. We understand that our Organization does not acquire or possess any illegal proceeds.

Yes No

Khalid Alhassawi Auditing (KAA)


Office No: 1011, Mazaya Shopping Centre, Sheikh Zayed Road - Dubai U.A.E.
Email: [email protected] Phone: (+971) 435-206-46
7. We understand that our Organization does not assist any person (perpetrator) in any money
laundering related activity.

Yes No

8. We understand that our Organisation's shareholders, directors, officers or employees are not
senior officials in government, political organisations or government-owned organisations, or
are not direct family members or associates of any such officials or PEP (Politically Exposed
Person) or relative of PEP.

Yes No

9. We understand that our Organisation’s shareholders, directors, officers or employees have


not been subject to any disciplinary action by a court, professional body or regulatory agency
either in the UAE or anywhere in the world.

Yes No

10. We understand that our Organisation's shareholders, directors, officers or employees are
independent from Enterprise House & its associated firms, or are not in any way related or
associated with it?

Yes No

11. We understand that our Organisation is not a party to any litigation and/or dispute whether in
any Court of law and/or tribunal that is in progress either in the UAE or anywhere in the world.

Yes No

12. We understand that we are fully in compliance with the Sanctions list** as set out and
enumerated in the UAE Federal Law on AML and CFT.

Yes No

13. If the answer to any of the above mentioned questions is ‘No’ give full particulars of the
relevant matter. (Attach additional sheet, if required)

14. Are there any other matters, which you believe we should be aware of before we onboard
you forthe services that you require?

Khalid Alhassawi Auditing (KAA)


Office No: 1011, Mazaya Shopping Centre, Sheikh Zayed Road - Dubai U.A.E.
Email: [email protected] Phone: (+971) 435-206-46
**Sanctions List
 Cabinet Decision No. 20 of 2019 regarding Terrorism Lists Regulation and Implementation of UN Security
Council Resolutions on the Suppression and Combating of Terrorism, Terrorist Financing and Proliferation
of Weapons of Mass Destruction, and Related Resolutions.
 Cabinet Decision No. 74 of 2020 Regarding Terrorism Lists Regulation and Implementation of UN Security
Council Resolutions On the Suppression and Combating of Terrorism, Terrorists Financing & Proliferation
of Weapons of Mass Destruction, and Related Resolutions.
 United Nations Security Council resolutions under Chapter VII of the Charter of the United Nations
regarding the prevention and suppression of terrorism and Terrorism Financing, and the prevention and
suppression of the proliferation of Weapons of Mass Destruction and its financing (Targeted Financial
Sanctions).
 Financial Action Task Force (FATF).
 The Middle East and North Africa Financial Action Task Force (MENAFATF)
 The United States Department of the Treasury’s Office of Foreign Assets Control (OFAC).
 The European Union’s Common Foreign and Security Policy (CFSP).
 The United Kingdom’s:
Terrorist Asset-Freezing Act 2010 (TAFA 2010).
Counter Terrorism Act 2008 (CTA 2008).
Anti-Terrorism, Crime and Security Act 2001 (ATCSA 2001).

Declaration
I hereby declare that the information provided herein is true and accurate and to the best of my
knowledge and belief. By signing below, I acknowledge and understand that the Firm shall undertake
client due diligence to its satisfaction in compliance with the regulatory requirements.

Further, I acknowledge that based on the outcome of the client due diligence, the Firm at its sole
discretion reserves the right to proceed or not to proceed with the client onboarding without any
liabilities whatsoever.

I acknowledge that if any information provided by me is subsequently found to be untrue, inaccurate


or misleading, the Firm could terminate our assignment and would be at liberty to take any further
action in accordance with law. I further acknowledge and undertake that the Firm shall not be held
responsible or liable in any manner and of nature whatsoever for any information found to be untrue,
inaccurate or misleading as provided by us herein.

I confirm that I am an authorized signatory / representative of the below company, and that all the
information declared, and documents provided herein are true and accurate.

Name:
Designation:
Company
Name:

If you have any questions or require further guidance in the completion of this sheet or our requirements
in general, please contact [email protected]

Khalid Alhassawi Auditing (KAA)


Office No: 1011, Mazaya Shopping Centre, Sheikh Zayed Road - Dubai U.A.E.
Email: [email protected] Phone: (+971) 435-206-46

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