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Politically Exposed Person Disclosure Form

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Politically Exposed Person Disclosure Form

This Politically Exposed Person Disclosure Form (the "Form") is entered into by and between Client Name: (the "Client") and Institution Name: (the "Institution"), effective as of the date set forth in the signature block below.

RECITALS

WHEREAS, the Institution maintains client identification, due diligence, and anti–money laundering procedures that require disclosure when a client, beneficial owner, or related person is a Politically Exposed Person ("PEP"); and

WHEREAS, the Client or the Client's designated subject has information relevant to PEP status that must be disclosed to the Institution and certified under penalty of perjury to permit lawful ongoing business relationships; and

WHEREAS, the parties desire to record the disclosures, consents and certifications required for the Institution to meet its regulatory obligations and to set forth the Client's continuing duties to inform the Institution of changes in status.

NOW THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows:

1. DEFINITIONS

For purposes of this Form, "Politically Exposed Person" or "PEP" means an individual who is or has been entrusted with prominent public functions, including senior executive, legislative, administrative or judicial roles, senior management of state-owned enterprises, and senior officials of major political parties, together with immediate family members and close associates as defined by the Institution's policies. The term also includes any person who holds or is reasonably expected to hold a function that may give rise to heightened reputational or legal risk.

2. SUBJECT IDENTIFICATION

Full legal name of subject:

Date of birth: Month Day Year

Nationality/Citizenship:

Current principal position or title:

Jurisdiction of office or public function:

3. PEP STATUS AND RELATIONSHIPS

Indicate whether the subject is a PEP and describe the relationship and scope of the public function. Check all that apply:

Head of state or government, head of major political party, or holder of similar office
Senior political, judicial, or military official
Senior executive of a state-owned enterprise or public international organization
Immediate family member of a PEP (spouse, partner, parents, siblings, children, in-laws)
Close associate of a PEP (business or other close relationship)

Describe the nature of the relationship to any identified PEP(s) and provide names of related individuals or entities, including any positions held by those related persons:

4. TRANSACTION AND SOURCE OF FUNDS

Describe the nature of the business relationship or transaction that gives rise to this disclosure, including account numbers, transaction types, or contract references:

Source(s) of funds or wealth supporting the relationship/transaction (summarize origin and principal sources):

5. REPRESENTATIONS, WARRANTIES AND CERTIFICATION

The undersigned hereby represents and warrants that the information provided in this Form is true, complete and accurate to the best of the undersigned's knowledge and belief, and that no material information has been omitted. The undersigned understands that the Institution may rely on this Form in conducting due diligence, and that knowingly providing false or misleading information may expose the undersigned to civil or criminal liability.

The undersigned further certifies that they are duly authorized to provide this disclosure on behalf of the Client where applicable, and will promptly notify the Institution in writing of any material change in circumstances affecting the accuracy of this disclosure within thirty (30) calendar days of such change.

6. USE, CONFIDENTIALITY AND CONSENT

The Institution may use the information provided in this Form to verify identity, to perform screening against public and proprietary databases, and to satisfy regulatory compliance obligations. The Institution will treat the information as confidential in accordance with its policies, except to the extent disclosure is required by law, subpoena, court order, or regulatory authority.

By signing below, the undersigned consents to the Institution's collection, use, retention and disclosure of personal data as described in this Form for the purposes set forth herein, including cross-border transfers where necessary for verification and regulatory reporting.

7. ONGOING OBLIGATIONS

The Client agrees to provide updates to this disclosure promptly upon becoming aware of any change in PEP status, related-party relationships, material changes in source of funds, or any other circumstance that could affect the Institution's risk assessment or compliance obligations. Failure to provide timely updates may result in enhanced due diligence measures, account restrictions, or termination of the relationship.

8. NOTICES

Notices under this Form shall be in writing and delivered to the addresses set forth above or such other address as a party may designate by written notice in accordance with this section. Notices are effective upon receipt.

9. GOVERNING LAW

This Form shall be governed by and construed in accordance with the laws of the jurisdiction specified by the Institution in its client agreement or, if none is specified, the laws of the jurisdiction in which the Institution maintains its principal place of business, without regard to conflict of law principles.

10. ENTIRE AGREEMENT

This Form, together with any related client agreement and supporting documentation, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior representations, understandings and agreements, whether written or oral, relating to the subject matter.

11. SEVERABILITY

If any provision of this Form is held to be invalid or unenforceable by a court of competent jurisdiction, the remaining provisions shall continue in full force and effect and the parties shall negotiate in good faith a substitute, valid provision to carry out the original intent.

12. AMENDMENTS, WAIVER AND COUNTERPARTS

No amendment to this Form will be effective unless in writing and signed by both parties. Waiver of any breach shall not constitute waiver of any other or subsequent breach. This Form may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument.

13. ACKNOWLEDGMENT

The undersigned acknowledges that the Institution may retain copies of this Form and any supporting documentation in accordance with applicable record retention requirements and that screening results or related information may be disclosed to regulators or law enforcement as required by law.

SIGNATURES

Client

Printed Name:

By:

Date:

Title (if signing on behalf of Client):

Institution

Printed Name:

By:

Date:

Title:

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What the Politically Exposed Person Disclosure Form Is

The Politically Exposed Person Disclosure Form is a standardized declaration used by financial institutions, corporate compliance teams, and other regulated entities to capture whether an individual or a close associate holds a prominent public position. The form documents identity details, public office held, nature of the relationship to the customer, and any associated financial or business activities subject to enhanced due diligence. Its purpose is to support anti-money laundering (AML) and know-your-customer (KYC) programs, to record screening results, and to create an audit trail for regulatory reviews.

Why a Formal PEP Disclosure Matters

Using a formal Politically Exposed Person Disclosure Form helps organizations document PEP status consistently, meet AML/KYC requirements, and provide a reproducible audit record for internal reviews and external regulators. It reduces compliance risk by standardizing due-diligence triggers and screening outcomes.

Why a Formal PEP Disclosure Matters

Typical Users and Responsible Parties

Typical users of the Politically Exposed Person Disclosure Form include bank compliance teams, private wealth managers, onboarding officers, and legal counsel involved in KYC reviews.

  • Bank compliance teams review disclosures to trigger enhanced due diligence and suspicious activity reporting.
  • Private wealth and asset managers assess PEP exposure to inform investment acceptance and risk limits.
  • Corporate legal and compliance counsel maintain records, advise on regulatory thresholds, and handle escalation.

Organizations often assign a central owner for PEP disclosures to ensure consistent screening and recordkeeping.

Core Sections Included in a Professional PEP Disclosure

A professional Politically Exposed Person Disclosure Form organizes identity, role, relationships, and financial disclosures into clear sections to support screening, risk scoring, and audit-ready recordkeeping.

Identification

Enter full legal name, date of birth, government-issued ID number, citizenship, and primary business address. Accurate identification supports sanctions screening and reduces false positive matches during automated checks.

Political Role

Describe the public office or political position, including title, jurisdiction, and term dates. Include whether the role is current, former, honorary, or ceremonial to clarify exposure level.

Relationships

List immediate family members and close associates with their relationship, positions held, and any shared business interests. Connections often determine the scope of enhanced due-diligence requirements.

Financial Interests

Disclose direct and indirect financial holdings, corporate roles, and beneficial ownership stakes that could present conflicts or require monitoring under AML policies including relevant account details and dates of acquisition.

Declarations

Affirm any political activities, gifts, or protocol duties, and certify truthfulness. Provide signature, printed name, capacity, and date to attest to the accuracy of the disclosure.

Audit Trail

Record screening results, reviewer notes, version history, and timestamps. Maintain attachments such as ID scans, approval records, and enhanced due-diligence documentation for regulatory inspection upon request by regulators.

Required Information at a Glance

Full legal name: Enter as shown on government-issued ID.
Position and office: Title, jurisdiction, and term dates.
Country of service: Country where public office is held.
Relationship to customer: Immediate family or close associate.
Financial interest summary: Known holdings and beneficial ownership.
Signature and date: Handwritten or electronic signature plus date.

Step-by-Step: Completing and Submitting the Form

Follow these steps to complete and submit the Politically Exposed Person Disclosure Form accurately and efficiently.

  • 01
    Prepare documents: Gather ID, proof of address, and supporting records.
  • 02
    Complete fields: Enter required data using specified formats.
  • 03
    Attach evidence: Upload legible scans and name files clearly.
  • 04
    Review & sign: Confirm accuracy, then sign and date the form.

How to Configure an Online PEP Disclosure Workflow

When configuring an online PEP disclosure workflow, set validation rules, conditional logic, and storage locations to align with compliance needs.

Field Configuration
Name field Required | Auto-detect and validate against government ID
Date fields MM/DD/YYYY | Date picker with format enforcement
Relationship Conditional | Reveal family fields for related individuals
Attachments Required | Accept PDF/JPEG; limit 10MB per file
Signature eSign | ESIGN/UETA compliant, audit trail stored

Platforms, Formats, and Integrations to Consider

Digital submission options include in-person paper, electronic upload, and eSignature-enabled web workflows compatible with common enterprise systems.

  • Integrations: Salesforce, NetSuite, Microsoft 365 supported
  • File formats: PDF, DOCX, and image uploads accepted
  • Authentication: Email, SMS, or advanced ID verification

Where to Send and How the Submission Flows

Typical submission flow routes the completed PEP disclosure through verification, review, and final approval with records retained for audit and regulatory reporting.

  • Upload: Signer uploads completed form and attachments.
  • Verify: System runs sanctions and watchlist screening.
  • Review: Compliance team records findings and decisions.
  • Store: Save final form with audit trail and documents.

Typical Timelines and Processing Expectations

Deadlines and processing expectations depend on the requesting institution and onboarding timelines; some providers require disclosure before account opening.

Initial request timing:

Typically requested during account opening or material transaction review.

Response expectation:

Expect a 3–10 business day turnaround for verification.

Expedited checks:

Faster screening can complete in 24–72 hours with additional verification.

Processing delays:

Incomplete fields or mismatched IDs cause delays and re-requests.

Record availability:

Finalized disclosures are kept for internal review and audits.

Penalties and Risks from Incorrect or Missing Disclosures

Regulatory fines: Possible monetary penalties and enforcement actions.
Account restrictions: Freezing, denial, or enhanced monitoring.
Reputational harm: Public disclosure and client trust erosion.
Operational burden: Increased due-diligence workload and costs.
Transaction delays: Slower onboarding and payment holds.
Civil liability: Potential lawsuits for negligent screening.

Common Preparation Mistakes to Avoid

  • Incomplete or inconsistent names and dates lead to failed watchlist matches and repeated information requests from compliance teams, delaying onboarding and increasing manual review time.
  • Failing to disclose close associates, family ties, or beneficial ownership creates compliance gaps that may trigger higher-risk assessments and retrospective investigations.
  • Using scanned images that are illegible, missing metadata, or mismatched file names complicates verification and often requires resubmission or notarized proofs.
  • Relying on manual processes without conditional fields or validation increases human error and makes demonstrating consistent KYC practices during audits difficult.

Comparison: eSignature Vendor Pricing and Key Capabilities

This vendor comparison summarizes starting prices and key capabilities relevant to eSigning Politically Exposed Person Disclosure Forms; signNow is shown first for reference.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Varies Varies Varies Varies
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No
Envelope Cap No cap 100 env/user/year Varies Varies Varies

Industry Examples and Real-World Outcomes

Organizations in real estate, finance, and legal services use eSigned PEP disclosures to streamline onboarding while preserving audit trails and compliance documentation.

Optica Ventures

Optica Ventures adopted electronic disclosures to simplify client interactions and reduce back-and-forth paperwork during onboarding.

  • The interface is simple and easy-to-use for our team.
  • By switching to electronic PEP disclosures, Optica Ventures reports faster responses from clients, fewer missing documents during onboarding, and an auditable record that supports compliance checks and reduces manual follow-up.

Martin Properties

Martin Properties moved disclosure and signature steps online to reduce in-person meetings and accelerate lease and transaction approvals.

  • I can process and execute all of these documents online.
  • The firm now completes PEP screening and disclosures with consistent security controls, obtains signatures across devices, and preserves timestamps and audit logs that simplify regulatory reporting and internal oversight.

Practical Tips for Accurate, Efficient Completion

Adopt standardized formats, enforce validation, and retain clear audit trails to maintain defensible PEP screening and disclosure practices.

Use consistent data formats
Define exact field formats, require MM/DD/YYYY dates, enforce name matching to government ID, and use conditional fields to surface only relevant questions. Consistency prevents processing delays and strengthens automated screening accuracy during audits.
Enable conditional logic and validation
Use conditional fields to request family and associate details only when applicable, reducing signer burden. Pair logic with field validation and required attachments to minimize incomplete submissions and manual follow-up by compliance reviewers.
Maintain clear and complete audit trails
Log each action with timestamp, IP address, signer attribution, and document version. Store a certificate of completion alongside attachments. Retaining this metadata satisfies record reproduction requirements under ESIGN and supports regulatory inquiries.
Secure storage, access controls, retention policy
Implement encrypted storage, TLS 1.2/1.3 in transit, AES-256 at rest, role-based access controls, and documented retention schedules to meet compliance and audit requirements. Ensure HIPAA BAA where PHI exists and follow IRS retention minima for tax records.

Who Typically Signs or Approves the Form

Compliance Officer

A Compliance Officer coordinates collection and review of PEP disclosures, defines screening thresholds, documents enhanced due-diligence steps, and signs off on high-risk determinations. They ensure the program aligns with AML/BSA procedures and maintain records for regulator inspections.

Legal Counsel

In-house or external legal counsel reviews disclosure language, advises on jurisdictional requirements, handles privacy considerations, and supports responses to regulator inquiries. Counsel assists in drafting notices and consent language consistent with ESIGN and state law.

FAQs: Common Questions About the PEP Disclosure Form

Answers to common questions about completing, signing, and submitting the Politically Exposed Person Disclosure Form, including eSignature and recordkeeping concerns.


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