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PEP Declaration Form

The PEP Declaration Form requires individuals to declare their status as a Politically Exposed Person (PEP) or provide information about immediate family members or close associates who are PEPs. There are four alternatives to choose from based on the individual's situation. The form also includes a confirmation statement regarding the accuracy of the information provided and the obligation to report any changes in status.

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Swati
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11 views2 pages

PEP Declaration Form

The PEP Declaration Form requires individuals to declare their status as a Politically Exposed Person (PEP) or provide information about immediate family members or close associates who are PEPs. There are four alternatives to choose from based on the individual's situation. The form also includes a confirmation statement regarding the accuracy of the information provided and the obligation to report any changes in status.

Uploaded by

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

PEP Declaration Form

Please complete the relevant Alternative option, which reflects your status.

1. ALTERNATIVE ONE:

I am a Politically Exposed Person (“PEP”) or have been PEP during the last year

If you have checked this box, please provide the following information:

Title:_____________________________________________________________________________

Description of Function and Level/Seniority:_____________________________________________

Date when you became a PEP:___________________________________________________________

If you were but no longer are PEP, date when the appointment ended :___________________

2. ALTERNATIVE TWO:

An immediate family member or a close associate is a PEP or has been a PEP during the
last year.

If you have checked this box, please provide the following information:

If the PEP is an immediate family member, please specify the relationship: Spouse/legal
cohabitant Parent/Children/spouse or legal cohabitant of your Children

If the PEP is a close associate, please describe the nature of the association:

_____________________________________________________________________________

3. ALTERNATIVE THREE:

I am not a PEP

4. ALTERNATIVE FOUR:

My PEP status as previously advised remains unchanged

1|P a g e [Link]
I hereby confirm that all the information and any documentation supplied with this form is
genuine, complete and correct.

I hereby confirm that I will inform Apex of a change in my status as detailed in this Form
should it change in the future.

Name & Surname: ______________________________________________________

Date: _______________________ Signature: ________________________

2|P a g e [Link]

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