KNOW YOUR CUSTOMER (KYC): INDIVIDUALS FORM

THIS KYC FORM MUST BE COMPLETED IN BLOCK CAPITAL LETTERS AND SIGNED BY THE POLICYHOLDER.

The following documents should be provided for verification in accordance with the Financial Intelligence Regulations:

  • Identification document e.g. Certified copy of ID, Passport/ Work and residence permit for foreign nationals.
  • Source of funds /Proof of Income e.g. pay slip, bank statement, confirmation of employment letter.
  • Proof of residence-Utility bill (not more than 3months) or lease agreement or tittle deed or letter from employer or affidavit from Commissioner of Oaths.

PROMINENT INFLUENTIAL PERSON – SELF DECLARATION

AS PER THE FINANCIAL INTELLIGENCE ACT, ANY PROMINENT INFLUENTIAL PERSON (PIP) / POLITICALLY EXPOSED PERSON (PEP) MUST COMPLETE THE BELOW SELF DECLARATION.

Please tick the relevant box, indicating the position you hold or held (within the last 5 years):

Head of State, Head of Government, Minister or Deputy or Assistant Minister
Speaker or Deputy Speaker of the National Assembly
Councillor
Senior Government Official
Judicial Officer
Member of Parliament (or similar Legislative Body)
Senior Executive of a Private Entity or Public Body or Political Party
Kgosi
Religious Leader
Senior Executive of International Organisation operating in Botswana

During what time period is / was the position held:

PIP / PEP IN YOUR IMMEDIATE FAMILY AND OR / WHO IS A CLOSE ASSOCIATE.

During what time period is / was the position held:

I hereby declare that the details provided above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misrepresenting, I am aware that I may be liable for it.



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