High Risk / PEP KYC - FIASERV eKYC

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High Risk / PEP Individual - KYC Form

Fields marked * are mandatory.

Personal Information

Full Name of Customer *

Date of Birth *

ID Document Type *

ID / Passport Number *

Place of Birth

Country of Birth

Country of Residence *

PEP Designation / Political Position

PEP Jurisdiction (Country)

Industry *

Occupation *

Customer Type *

Residential Address *

Source of Funds

Source of Funds *

Source of Funds - Details

Source of Wealth *

Adverse Media Screening

Adverse / Negative Media Screening Notes

Adverse Media Screening Screenshot

Financial Clearing Bureau Screening

Financial Clearing Bureau Screening Notes

Financial Clearing Bureau Screenshot / Printout

Senior Management Sign-Off

Senior Management Approval Obtained *

Name of Approving Officer

Approval Date

Approval Notes / Justification

Senior Management Sign-Off Document

Supporting Documents

ID Document / Passport / Permit

Proof of Residential Address

Source of Funds Document

Source of Wealth Document

Additional Notes

Notes