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    Know Your Customer Form

    Uploaded by

    Taufik Hameed Sultan
    This document is a Know Your Customer (KYC) form required by Syarikat Takaful Malaysia Keluarga Berhad and Syarikat Takaful Malaysia Am Berhad to conduct due diligence on prospective business relationships and transactions. The form collects corporate details, declarations of ultimate beneficial ownership, and confirmation that the information provided is accurate. It also defines terms like politically exposed persons, family members, and close associates. Supporting documents are required depending on the type of entity.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Know Your Customer Form

    Uploaded by

    Taufik Hameed Sultan
    36 views3 pages
    This document is a Know Your Customer (KYC) form required by Syarikat Takaful Malaysia Keluarga Berhad and Syarikat Takaful Malaysia Am Berhad to conduct due diligence on prospective business relationships and transactions. The form collects corporate details, declarations of ultimate beneficial ownership, and confirmation that the information provided is accurate. It also defines terms like politically exposed persons, family members, and close associates. Supporting documents are required depending on the type of entity.

    Original Title

    Know Your Customer Form (4)

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    This document is a Know Your Customer (KYC) form required by Syarikat Takaful Malaysia Keluarga Berhad and Syarikat Takaful Malaysia Am Berhad to conduct due diligence on prospective business relationships and transactions. The form collects corporate details, declarations of ultimate beneficial ownership, and confirmation that the information provided is accurate. It also defines terms like politically exposed persons, family members, and close associates. Supporting documents are required depending on the type of entity.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    36 views3 pages

    Know Your Customer Form

    Uploaded by

    Taufik Hameed Sultan
    This document is a Know Your Customer (KYC) form required by Syarikat Takaful Malaysia Keluarga Berhad and Syarikat Takaful Malaysia Am Berhad to conduct due diligence on prospective business relationships and transactions. The form collects corporate details, declarations of ultimate beneficial ownership, and confirmation that the information provided is accurate. It also defines terms like politically exposed persons, family members, and close associates. Supporting documents are required depending on the type of entity.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 3

    KNOW YOUR CUSTOMER (KYC) FORM

    The information in this KYC form is required for Syarikat Takaful Malaysia Keluarga Berhad (“STMKB”) / Syarikat Takaful Malaysia Am Berhad
    (“STMAB”) to conduct due diligence exercise to the prospective business relationship or transaction with you as part of our effort to comply with the
    relevant laws.

    Please complete all the parts. Any incomplete or unverified information may trigger us to make further queries or we may refuse to enter into any
    business relationship or transaction with you.

    PART A: CORPORATE DETAILS


    Name of entity
    Company incorporated in  Company incorporated
     Partnership  Sole proprietorship  Others
    Type of entity Malaysia outside Malaysia
    If others, please specify
    Entity/Business registration no.
    Date of establishment
    Place of establishment
    Industry / Nature of business
    Website
    Registered address
    Business address
    Office no.
    Fax no.
    Email address

    PART B: DECLARATION OF ULTIMATE BENEFICIAL OWNERSHIP


    I/We hereby declare as the beneficial owners, i.e. individual(s) who ultimately own(s) or effectively control(s) the company (regardless of
    shareholding), and the percentage shares held by the beneficial owners of the Company are as follows.
    (in case the space provided is insufficient, please provide the information by attaching separate declaration forms)
    Name NRIC No./Passport No. Relationship with company Nationality % shares

    PART C: OTHER DECLARATIONS

    No. Query Yes ( ) No ( )


    Has the entity been convicted for any criminal offences or subject to administrative action / investigation in any
    a)
    jurisdiction?
    Has the entity been directly or indirectly involved in any charges or proceedings relating to money laundering or
    b)
    terrorism financing or any unlawful activity in any jurisdiction?
    Are there any pending or threatened winding-up, insolvency, liquidation or dissolution proceedings that the entity is
    c)
    currently undergoing?
    d) a) Are any of your shareholders or directors a Politically Exposed Person (PEP)? If yes, please provide the following
    details.

    No. Name of shareholder(s)/director(s)

    (in case the space provided is insufficient, please provide the information by attaching separate declaration forms)
    b) Are any of your shareholders or directors a Family Member to any PEP? If yes, please the following provide
    details.

    No. Name of shareholder(s)/director(s) Name of PEP(s)

    (in case the space provided is insufficient, please provide the information by attaching separate declaration forms)
    c) Are any of your shareholders or directors a Close Associate to any PEP? If yes, please provide the following
    details.

    No. Name of shareholder(s)/director(s) Name of PEP(s)

    (in case the space provided is insufficient, please provide the information by attaching separate declaration forms)

    PART D: TERMS AND CONDITIONS

    STMKB / STMAB may require you to provide further information or documentation upon reasonable request, from time to time. STMKB / STMAB
    reserves the right to terminate our business relationship or transaction with you, in the event it is discovered that any information or document provided
    is false, inaccurate or misleading.

    Personal Data Protection:


    STMKB / STMAB shall comply with the applicable laws on personal data protection including Personal Data Protection Act 2010 (PDPA 2010), in
    order to collect, use, process, record, hold, store, share and/or disclose any or all personal data related to the performance and obligations for the
    purpose of conducting the due diligence process.
    By completing and signing this KYC Form, you agree that we may share your personal data (currently or subsequently held) for the purpose of
    compliance with our audit requirements, regulatory requirements, legal obligations and contractual obligations in respect to our services herein.
    STMKB / STMAB shall implement adequate technical and organisational security measures to protect the personal data from any loss, misuse,
    modification, unauthorised or accidental access or alteration, disclosure or destruction of your personal data.
    In the event that your company is not selected to engage in any business relationship with STMKB / STMAB, we may keep all documents submitted
    for a period of six (6) months for the purpose of considering your company’s potential in other services. After the period ended and if there is no
    positive prospect to it, STMKB / STMAB shall ensure that the said documents to be permanently deleted or permanently dispose from our records.

    PART E: CONFIRMATION
    The above information is true to the best of my/our knowledge, correct and
    accurate.

    Date: _ _/_ _/_ _ _ _ NAME & SIGNATURE OF AUTHORISED PERSON


    PART F: GENERAL INFORMATION

    DEFINITION OF TERMS
    Close Associates Refers to any individual closely connected to a PEP, either socially or professionally.
    An individual who is closely connected to a PEP may include the PEP’s:
    a) extended family members, such as relatives (biological and non-biological relationship);
    b) financially dependent individuals (i.e. persons salaried by the PEP such as drivers, bodyguards, secretaries);
    c) business partners or associates;
    d) prominent members of the same organisation as the PEP;
    e) individuals working closely with the PEP (i.e. work colleagues); or
    f) close friends.
    Family Member Refers to individuals who are related to a PEP either directly (consanguinity) or through marriage.
    Family member of the PEP includes the PEP’s:
    a) parents*;
    b) siblings*;
    c) spouse(s);
    d) child*; or
    e) spouse's parents*;
    * biological and non-biological relationship
    Politically Exposed Refers to:
    Person (PEP) a) foreign PEPs – individuals who are or who have been entrusted with prominent public functions by a foreign
    country. For example, Heads of State or Government, senior politicians, senior government, judicial or military
    officials, senior executives of state owned corporations and important political party officials;
    b) domestic PEPs – individuals who are or have been entrusted domestically with prominent public functions. For
    example, Heads of State or Government, senior politicians, senior government, judiciary or military officials,
    senior executives of state owned corporations and important political party officials; or
    c) persons who are or have been entrusted with a prominent function by an international organisation which refers
    to members of senior management. For example, directors, deputy directors and members of the board or
    equivalent functions.
    The definition of PEPs is not intended to cover middle ranking or more junior individuals in the foregoing categories.

    PART G: SUPPORTING DOCUMENTS

    Please provide the following supporting documents


    No. Types of Entity Document(s) (Certified true copy)
    1. Company (a) Memorandum and Article of Association or Constitution OR written confirmation duly signed by a
    incorporated in director confirming that the Company does not have Constitution;
    Malaysia (b) Form 9 (Certificate of Incorporation of Private Company) OR Companies Act 2016 – Section 14 & 15
    OR Certificate of Registration under Ordinan Nama-Nama Perniagaan of Sarawak OR Form B -
    Certificate of Registration under Commercial Licence Ordinance 1948 for Sabah;
    (c) Form 24 (Complete Return of Allotment of Shares Form)/ Annual Return OR Companies Act 2016 -
    Section 78;
    (d) Form 44 (Notification of Change in the Registered Address Form) OR Companies Act 2016 – Section
    46;
    (e) Form 49 (Notification of Change in the Register of Directors, Managers and Secretaries Form) OR
    Companies Act 2016 - Section 58 & 236(2); AND
    (f) Letter of authorisation and identification documents (NRIC/passport) for authorised representatives;
    OR
    (g) Powers that regulate and bind customers i.e. Directors’ Resolution/ names of Senior Management
    2. Company a) Documents equivalent to the documents required for companies incorporated in Malaysia from a-f
    incorporated outside b) Company profile
    Malaysia c) Brochures on products/services
    3. Sole Proprietorships, Business Registration Certificate (or equivalent)
    Partnerships and
    Others

    PART H: FOR OFFICE USE ONLY

     All required information completed


     Receipt of all required documents in Certified True Copy (CTC) form

    NAME AND SIGNATURE OF STMKB /STMAB OFFICER IN


    CHARGE

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