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Pep Declaration Form

The document is a Politically Exposed Person (PEP) Declaration Form designed to collect information for compliance with anti-money laundering and anti-terrorism financing regulations. It defines a PEP and outlines various profiles that qualify as such, including heads of state, senior politicians, and their immediate family members. The form requires individuals to declare their PEP status and provide details if they are related to a PEP.

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14 views1 page

Pep Declaration Form

The document is a Politically Exposed Person (PEP) Declaration Form designed to collect information for compliance with anti-money laundering and anti-terrorism financing regulations. It defines a PEP and outlines various profiles that qualify as such, including heads of state, senior politicians, and their immediate family members. The form requires individuals to declare their PEP status and provide details if they are related to a PEP.

Uploaded by

oceangoldanddiamond
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

POLITICALLY EXPOSED PERSON (PEP) DECLARATION

FORM
The information in this form is collected to comply with the Anti-Money Laundering, Anti-Terrorism
Financing and Proceeds of Unlawful Activities requirement.

A politically exposed person (PEP) is an individual who is or who has been entrusted with prominent
public functions domestically’ or by a foreign country.

Prominent public functions include the following profiles:

1. Head of State or of Government 2. Senior politician

3. Senior government, judicial or military official 4. Member of the ruling royal family

5. Senior executive of state-owned corporation / government linked company 6. Important political party
official

The definition of PEP also includes immediate family members, relatives, adviser, personal adviser, or
business associate as stated above.

[Link] you a PEP (Any shareholder, UBO, Authorized person, Senior Manager)? Yes No 

[Link] you or the entity related to a PEP? Yes No 

(Please fill the below questions if the first two questions you answered - yes)

[Link] you are related to PEP, please indicate the profile and relationship to you:

A. Head of State or of Government B. Senior politician

C. Senior government, judicial or military official D. Member of ruling royal family

E. Senior executive of state-owned corporation / Government linked company

F. Important political party official G. Other…………………….

I hereby declare that the details and information given above are complete and true to the best of
my knowledge.

Name: Nehal Dilip Sagar Designation: Partner/Manager Date: 19/11/2025

____________________
Signature

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