Individual Due Diligence Questionnaire | Verification Evidence and Employment Details | Beneficial Owners and Background Searches and Checks | Template for FCA Applications and Authorised Firms

[Your Company Name] Due Diligence Questionnaire

1 Personal Details

Title:     _______________                                         Surname:    _______________

First Name:    _______________                               Middle Name(s):    _______________

Previous Name(s) or Aliases:    ______________________________

Address:    _____________________________________________

Time at Address:    ________  If at current address less than 3 years, provide previous address.

Previous Address:    _____________________________________________

Gender:     M__  F__                                                      Date of Birth:    _______________

Home Phone:    _______________                               Work Place:    _______________

Mobile:    _______________                                          Email:    _______________

NI No:    _______________                                            Martial Status:    _______________

2 Verification Evidence 

a. Obtain 2 forms of identity verification from the below list*: –

• UK Passport
• UK/EU Photo Driving Licence
• National Identity Card
• State Pension/Benefits Book
• Armed Forced ID Card
• [Add/Delete as applicable]

b. Obtain 2 forms of address verification from the below list* (dated within last 3 months): –

• Council Tax Statement
• UK/EU Photo Driving Licence (if not already used for identity)
• Bank/Building Society Statement (excluding online statements)
• Mortgage/Rent Statement
• HMRC Tax Notification
• Utilities Bill – gas, electric, water etc (excluding mobile phone)

NOTE: *If the customer is subject to Enhanced Due Diligence (EDD), obtain 3 separate pieces evidence to validate both the customers identity and address.

3 Employment Details (If Applicable)

Company:    _______________                              Point of Contact:    _______________

Address:    _____________________________________________

Telephone:    _______________                            Time with Employer:    _______________

Position:    _______________                                 Employee No:    _______________

NOTE: *If the customer is subject to Enhanced Due Diligence (EDD), you should contact the employer to verify further information about them and obtain a written reference where applicable.

4 Beneficial Owner(s)

Where applicable, you must ensure that you have carried out enquiries to identify any beneficial owners involved in the service/transaction. If this is not applicable to the service being offered or no beneficial owner is involved, answer NO to question A and move on to section 5.

a. Are there any beneficial owners involved in this service/transaction?
YES/NO

b. If a beneficial owner(s) has been identified, include their details below: –

Name(s)/Description of Beneficial Owner:    _______________
Address:    ______________________________
DOB (if applicable):    _______________
Nationality:    _______________
Nature of Interest/Role:    _______________

*if EDD, provide additional information on the beneficial owner:

______________________________

______________________________

c. The Company has identified any beneficial owner(s) involved in this service/transaction and has taken reasonable measures to verify their identity; gain an understanding of any ownership and/or control structures of any trust or company or other arrangement and have obtained the relevant evidence to support these measures
YES/NO

5 Background Searches & Checks

Background checks and searches should be completed (except where simplified due diligence is valid) to verify the customers identity, employment and address. Searches should also be made where the service, product or transaction require verification of a customer’s financial, criminal and/or historical status. 

a. Has the employee’s address been verified via an electoral register search?
YES/NO

b. Have you validated the employee’s financial status (including any insolvencies, bankruptcies or relevant defaults/CCJ’s)?
YES/NO

c. Have you completed a CRB check?
YES/NO

d. Ensure that copies of all searches are saved/printed and retained with the completed due diligence form and note any relevant search information below: – 

Detail any relevant findings from conducting background searches and checks:

____________________________________________

____________________________________________

*For EDD, ensure that you carry out searches via 2 different credit providers (i.e. Experian and Equifax or use Check My File for listings of all four credit bureaus), to ensure a thorough background check and status is obtained.

6 Enhanced Due Diligence

Where EDD is required, ensure that the below is completed (if not already answered elsewhere in this document).

a. Provide additional information about the intended nature of the business relationship

____________________________________________

____________________________________________

b. Provide information on the reasons for the transaction(s):

____________________________________________

____________________________________________

Date Completed:        _______________________
Next Review Date:     _______________________
Completed By:            _______________________
Position:                     _______________________
Signed:                        _______________________

For EDD customers, obtain additional Senior Manager approval to continue to transaction/relationship:

Senior Manager:        _______________________
Signature:                   _______________________