Client's full name:
*
Client's date of birth:
*
MM
DD
YYYY
Client's address:
*
I have seen and retained copies of the following documents:
*
Customer due diligence means taking steps to identify your customers and checking they are who they say they are. In practice this means obtaining a customer’s: name photograph on an official document which confirms their *name*, *residential address* and *date of birth*. The best way to do this is to ask for a government issued document like a passport or driving licence, along with utility bills, bank statements or other official documents.
Passport
Driving licence
Utility bill
Bank statement
Other (specify below)
Is the client new or existing?
*
New
Existing
Client's Occupation / Source of income:
Is it unusual for this type of client to instruct us?
*
No
Yes (explain below)
Do you have any concerns about the client? (e.g., capacity, undue influence, vulnerability)
*
No
Yes (explain below)
If a third party is instructing, do you have evidence of their authority to act?
*
N/A
No
Yes, LoA provided.
Is the client a designated person/entity (i.e., listed)?
*
No
Yes
In which country is the client based?
*
Do you have any concerns about the client’s location?
*
No
Yes (see notes)
Does it make sense for the client to instruct us from this location?
*
Yes
No (see notes)
Overall, what level of risk is posed BY THE CLIENT?
*
Low
Medium
High
Matter Reference:
*
Matter description:
*
What is the total transaction value of the matter?
*
Do you usually carry out this type of work?
*
Yes
No
Does the matter involve creating a complex structure?
*
No
Yes (see notes)
Does the matter involve a cash-intensive industry?
*
No
Yes (see notes)
Does the matter involve a high-risk industry?
*
No
Yes (see notes)
Does the matter involve a risk of proliferation financing?
*
No
Yes (see notes)
Are there any overseas elements in the matter?
*
No
Yes (see notes)
Are there any other AML or Counter Terrorist Financing risks?
*
No
Yes (see notes)
Have you checked the source of funds for this transaction?
*
N/A
Yes
No (see notes)
Are we receiving funds from overseas?
*
No
Yes (see notes)
Are we receiving funds from a third party?
*
No
Yes (see notes)
Overall, what level of risk is posed BY THE MATTER?
*
Low
Medium
High
What level of customer due diligence will you apply?
*
Simplified
Standard
Enhanced
Notes:
Assessment conducted by:
*
First Name
Last Name