CUSTOMER ACCEPTANCE CHECKLIST Form

CUSTOMER ACCEPTANCE CHECKLIST

PART 1 – INFORMATION ABOUT CUSTOMERS, AGENTS, BENEFICIAL OWNERS AND POLITICALLY EXPOSED PERSONS.

Section A1 – Information of Customer/ Agent

Individual Customer’s / Agent’s Information

Capacity in which the individual is acting?

Self

Agent

Connected Party

Full Name(including any aliases)*

Residential Address*

Unique Identification Number/ Passport/FIN Number*

Expiry date of Identification Document (if applicable)

Date of Birth*

Gender

Male

Female

Nationality/Nationalities (where applicable)*

Contact Number(s) with Country Code*

Email Address(es)

Intended nature and purpose of business relationship (Please indicate the reason why you are seeking the services of the RFA) * Required information required under ACRA (Filing Agents and Qualified Individuals) Regulations 2015

Individual Customer’s / Agent’s Information (Leave If not applicable)

Capacity in which the individual is acting?

Self

Agent

Connected Party

Full Name(including any aliases)*

Residential Address*

Unique Identification Number/ Passport/FIN Number*

Expiry date of Identification Document (if applicable)

Date of Birth*

Gender

Male

Female

Nationality/Nationalities (where applicable)*

Contact Number(s) with Country Code*

Email Address(es)

Section A2 – Information on Business Entity

Entity’s Information

Name of entity or Name of proposed entity*

Unique Entity Number (UEN) issued by the Registrar*

Address or intended address of the registered office*

Address of principal place of business (if different from above)

Place or Proposed Place of registration*

Date or Proposed Date of registration*

Contact Number(s) with Country Code*

Email Address(es)

Intended nature and purpose of business relationship (Please indicate the reason why you are seeking the services of the RFA)

Name(s) of all connected parties (directors/partners)* (Please use section A1 to obtain information for each connected parties identified). * Required information required under ACRA (Filing Agents and Qualified Individuals) Regulations 2015

Section B – Information on Customer’s Beneficial Owner(s)

The purpose of obtaining beneficial owners’ information is to:
a) identify the natural persons (whether acting alone or together) who ultimately own all the assets or undertakings of the customer.
b) if there is doubt as to whether the natural persons who ultimately own all the assets or undertakings of the customer are the beneficial owners or where no natural persons ultimately own all the assets or undertakings of the customer, to then identify the natural persons (if any) who ultimately control the customer or have ultimate effective or significant control over the customer.
c) where no natural persons are identified above, to identify the natural persons having executive authority in the customer, or in equivalent or similar positions. (Please duplicate the section below if there is more than one Beneficial Owner)

Entity’s Information

Full name of beneficial owner (including any aliases)

Residential Address

Nationality

Date of birth

Unique Identification Number/Passport or FIN Number

Expiry date of Identification Document (if applicable)

Contact Number(s) with Country Code

Provide information of nature of beneficial ownership or person having executive authority (e.g. more than 25% of ownership of the customer)

Information on ownership and control structure of, or over the customer For customers that are legal persons, RFA should understand and provide the control structure when identifying who is the beneficial owner.

Section C1 – Information relating to Politically Exposed Person(s).

Politically Exposed Persons

Is the customer, agent, beneficial owner or any party connected to the customer, a Politically Exposed Person (PEP)10? A PEP includes the following:
a) a person who is or has been entrusted with any prominent public function in Singapore, a country or territory outside Singapore, or by an international organisation at present; or
b) a person who has been entrusted with any prominent public function in Singapore, a country or territory outside Singapore, or by an international organisation who has stepped down from his prominent public function; or
c) an immediate family member or a close associate of a politically exposed person or a politically exposed person who has stepped down.

Yes (Please complete Section C2 for each Identified PEP)

No (Please proceed to complete section D for the Customer Declarations)

Section C2 – Information about Politically Exposed Persons, their Immediate Family Members and Close Associates

Information on Political Exposed Person (PEP)

Is the customer, agent, beneficial owner or any party connected to the customer, a Politically Exposed Person (PEP)10? A PEP includes the following:
a) a person who is or has been entrusted with any prominent public function in Singapore, a country or territory outside Singapore, or by an international organisation at present; or
b) a person who has been entrusted with any prominent public function in Singapore, a country or territory outside Singapore, or by an international organisation who has stepped down from his prominent public function; or
c) an immediate family member or a close associate of a politically exposed person or a politically exposed person who has stepped down.

Name of PEP

Country which PEP holds prominent public function

Describe nature of prominent public function that the person is or has been entrusted with (for e.g. as a domestic politically exposed person, a foreign politically exposed person, or a politically exposed person of an international organisation)

Period of time in which the person is/ was a politically exposed person

Nature of PEP relationship with the customer (for e.g. self, family member, close associate, Ultimate Beneficial Owner etc)

Information on the person’s source of wealth

Information on the person’s source of funds in the proposed business relationship 10 Please refer to ACRA guidelines on who is a PEP. RFAs should obtain the above information for each PEP identified.

Section D - Customer’s/ Agent’s Declaration

I declare that the information provided in this form is true and correct.

*Name of Customer/ Agent

*Unique Identification Number/ Passport/FIN Number

Date

Signature