Client Particulars Form

CLIENT INFORMATION FORM
(INDIVIDUALS including Agents)

Explanatory Note to Clients on Anti-Money Laundering (AML) Regulations: All lawyers are required by law to perform identity & verification checks on transaction and risks, both prior to accepting instructions to act & on an on-going basis. Please note that we are required to maintain such documentation and records, which will be made available for disclosure to authorised officers if it is required for compliance with any of the AML regulations. We therefore seek your kind understanding and cooperation in the provision of all information requested as follows.

Property Address:
Ref No:		Lawyer/Secretary
Subject Matter: *

1. CLIENT PARTICULARS

(a)

Client’s Name (including aliases) *

(b)

Name of Beneficial Owner
(if individual is not the true Owner)

(c)

Residential Address *

(d)

NRIC No. / Passport No. *

(e)

Nationality

(f)

Date of Birth

(g)

Contact Number(s) & Email

(h)

Occupation & Job Title

(i)

Name of Employer in Full (if any)

(j)

Annual Income

(k)

Source of Funds for the purpose of this particular transaction (you may tick more than one)

(l)

Are you a *politically exposed person locally or overseas?

YES

(m)

Are you related or in close association with a *politically exposed person locally or overseas?

YES

2. DOCUMENTS TO BE PROVIDED

Please provide documents that have been indicated.

(a)

□ Copy of NRIC/Passport of the client certified as a true copy by the lawyer (where there is a face to face meeting with the client and the lawyer has sighted the original NRIC/Passport);
□ For Foreigners: Copy of Passport of the client certified as a true copy by the lawyer after sighting the Original AND Proof of Address document.
□ Original written verification of identity of client by an advocate and solicitor or a notary public in client’s jurisdiction together with certified true copy of the client’s identity document.

(b)

Powers of Attorney (Filled up by Attorney) – If applicable

□ Purpose of Power of Attorney:
Where the client is conferring a power of attorney,
□ details of the attorney (including Name, alias (if any), address, ID No., Date of Birth, Nationality etc) have to be provided together with a certified true copy of the Identity document (certified by a notary public of the relevant jurisdiction or a Singapore advocate and solicitor).
□ Original Letter from client confirming relationship with agent/attorney and that their agent/attorney has the authority to give instructions to .

3. DECLARATION

a) I hereby declare and confirm that the information above is, to the best of my knowledge, correct and accurate and have not willfully withheld any material fact or information from .
b) I shall give written notice of any change in my particulars throughout the course of the representation.
c) There are no legal proceedings against me in Singapore or otherwise, and I have not been convicted of any tax crimes.
d) I give consent to to contact me for the purpose of compliance with Regulatory Guidelines on Prevention of Money Laundering and Countering the Financing of Terrorism.
e) I will indemnify from any and all cost and expenses arising from as a result of any inaccurate information, false and misleading representation provided by me and relied upon by the firm.

Name of Client :
Date :

FOR OFFICIAL USE ONLY:

RISK PROFILE ASSESSMENT

□ Low Risk
□ To seek Advice / Approval of Senior Management for further compliance / risk mitigation measures
□ High Risk - Please Provide Reason(s)/ Comments ____________________________________________________________________________________

-> Please refer matter to Senior Management / Directors

Reviewed By Lawyer: (initial)
Date:

* “Politically Exposed Person” means-

1. A natural person who is or has been entrusted with prominent public functions whether in Singapore or a foreign country;
2. Immediate family members of such a person, or;
3. Close associates of such a person
“Prominent Public Functions” includes the roles held by a head of state, a head of government, government ministers, senior civil servants, senior judicial or military officials, senior executives of state owned corporations, and senior political party officials.

CLIENT INFORMATION FORM (INDIVIDUALS including Agents)