Can this form be signed electronically?

Yes. Electronic signatures are legally valid under the ESIGN Act (15 U.S.C. §7001) and UETA in most states when intent, consent, attribution, and record retention are satisfied.

Is notarization required?

Not generally required for internal PEP declarations, but some states or contract terms may request notarization; check state rules and contract language before requiring notarization.

What if the declarant changes status?

Request an updated declaration immediately upon a change in public office or relationship to ensure ongoing due diligence and support any necessary risk mitigation steps.

How should I store completed forms?

Store signed forms in secure, access-controlled systems with audit trails. For healthcare contexts follow HIPAA retention and security requirements (45 CFR §164.530(j)).

Who should sign for an organization?

The individual PEP or authorized representative should sign. A named compliance officer may also certify receipt, review, and decision in the compliance record.

What steps if a form is incomplete?

Flag the record, notify the declarant for completion, and withhold final account activation or transaction processing until the required fields and identity evidence are provided.

Electronic Signature
Templates
Miscellaneous
Politically Exposed Persons Declaration Form

Politically Exposed Persons Declaration Form

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

POLITICALLY EXPOSED PERSONS DECLARATION FORM

WHEREAS: Institution Name:

WHEREAS: The Institution requires accurate identification of individuals who are, or are related to, politically exposed persons in order to meet internal compliance obligations and to assess reputational and regulatory risk; and

WHEREAS: Declarant Name: submits this Declaration to confirm political exposure status and to authorize verification as permitted under applicable law.

1. IDENTIFICATION OF DECLARANT

Declarant Full Name Organization (if applicable) Position / Title

Date of Birth:

Nationality:

Identification Number:

Residential or Business Address

2. POLITICALLY EXPOSED PERSON STATUS

Please indicate your status. Check the box that best describes your current relationship to a Politically Exposed Person (PEP).

Are you a politically exposed person? I am a Politically Exposed Person (holding or having held a prominent public function). I am an immediate family member of a Politically Exposed Person. I am a close associate of a Politically Exposed Person.

If any of the boxes above are checked, provide the following details. If none apply, enter N/A.

Name of PEP (if other than declarant) Relationship to Declarant Office / Public Function Held Jurisdiction (Country / State) Period During Which Office Was Held Additional Details

3. DECLARATION, CONSENT AND UNDERTAKING

I, the undersigned Declarant, certify under penalty of law that the information provided in this Declaration is true, complete and accurate to the best of my knowledge. I acknowledge that knowingly providing false or misleading information may result in termination of the business relationship, regulatory reporting, and other lawful actions.

I consent to the Institution conducting such public record, identity and background checks, and to the Institution retaining and using the information provided for compliance, due diligence and reporting purposes as required by applicable law and internal policy.

Effective Date of this Declaration

Notification obligation: The Declarant agrees to inform the Institution in writing within 30 days of any change in the information provided that would affect the Politically Exposed Person status disclosed herein.

4. CONFIDENTIALITY

The Institution will treat information provided in this Declaration as confidential and will protect it in accordance with internal policies. The Institution may disclose such information as required by law, regulation, or supervisory authority, or where necessary to protect its legal interests. Such disclosures do not constitute a breach of confidentiality by the Institution.

5. GOVERNING LAW

This Declaration shall be governed by and construed in accordance with the laws of the jurisdiction of the Institution's principal place of business, without regard to conflict of law principles. The Declarant submits to the exclusive jurisdiction of the competent courts of that jurisdiction for disputes arising from this Declaration.

6. ENTIRE AGREEMENT

This Declaration, together with any related acknowledgements executed by the Declarant, constitutes the entire understanding between the parties with respect to the subject matter herein and supersedes all prior statements, proposals or representations, whether oral or written.

7. ACKNOWLEDGEMENT

By signing below, I acknowledge that I have read and understood this Declaration, that I have had the opportunity to ask questions and obtain clarifications, and that I voluntarily provide the information and consents contained herein.

Declarant:

Print Name:

Signature:

Title/Relationship:

Date:

What the Politically Exposed Persons Declaration Form Is

A Politically Exposed Persons Declaration Form is a written statement used to identify individuals who hold or have held prominent public positions, or their close associates and family members, when onboarding customers, counterparties, or suppliers. The form captures identity details, the public role or relationship that creates exposure, and a signed acknowledgment of the declaration. Organizations use the form to support risk-based due diligence, meet anti-money‑laundering and sanctions screening obligations, and document decisions made under internal compliance policies.

Why this Declaration Matters for Compliance

Collecting a Politically Exposed Persons Declaration reduces regulatory risk by documenting potential conflicts and exposure. Properly completed forms support AML screening, audit trails, and recordkeeping under ESIGN (15 U.S.C. §7001) and state electronic transaction rules.

Who Typically Completes This Declaration

The form is completed by individuals, their authorized representatives, or onboarding teams when a PEP relationship is relevant to a transaction or account.

Individual customers or beneficial owners completing onboarding or KYC records.
Compliance or onboarding officers documenting risk assessments for accounts or contracts.
Legal or HR representatives collecting declarations for employment, contracting, or benefits.

Maintain copies with the customer file and log the declaration date to support any later reviews or escalations.

Primary Signers and Submitters

PEP Individual

A person who holds or held a prominent public function, or a close family member/associate. The PEP signs to confirm identity and relationship and provides contact details and office information for due diligence.

Compliance Officer

An authorized employee or third-party agent who collects the signed declaration, verifies identity documents, records the outcome in AML systems, and retains the document per retention policy.

Core Elements of a Professional Declaration Form

A complete Politically Exposed Persons Declaration Form combines clear declarations, identity evidence, and metadata to support AML reviews, audits, and remediation steps.

Declarant Details

Full legal name, date of birth, contact information and relationship to the organization to uniquely identify the declarant and link to onboarding records.

Public Role

Name the office or position held, jurisdiction, dates in office, and the level of authority to establish exposure and screening scope.

Relationship Type

Specify whether the person is the PEP, a family member, or a known close associate; include the nature and degree of relationship.

Identification Evidence

List and attach government ID numbers or copies, and note method of identity proofing used for verification and audit.

Declaration Language

A clear statement signed by the declarant confirming accuracy of the information and consenting to checks and record retention.

Audit Data

Include signer identity, timestamp, reviewer notes, and a record of any escalations to compliance for future inspection.

Required Data Elements at a Glance

Full Name: Given and family names

Date of Birth: MM/DD/YYYY

Public Office: Title and jurisdiction

Relationship: Family or associate

ID Proof: Type and reference

Signature: Signed and dated

How to Complete the Declaration — Step by Step

Follow these sequential steps to complete and validate a Politically Exposed Persons Declaration accurately.

01

Gather Documents: Collect government ID and proof of relationship before starting.
02

Complete Fields: Enter name, office, dates, and relationship with required detail.
03

Attach Evidence: Upload ID scans and supporting documents securely.
04

Sign and Submit: Sign electronically or in person; route to compliance for review.

Typical Review and Submission Flow

A common operational flow ensures the declaration is captured, verified, and retained with minimal friction and clear handoffs.

Submit Form: Declarant completes form; attachments uploaded.
Automated Screening: System runs PEP and sanctions checks.
Compliance Review: Officer reviews matches and documents decision.
File Retention: Finalized file stored with audit trail.

Recommended Online Workflow Settings

Configure the digital form to balance signer convenience with required authentication and auditability.

Setting	Recommended Value
Authentication	Email + SMS OTP for moderate assurance
Conditional Fields	Show relationship questions only if PEP selected
Attachments	Require ID upload before submit
Reminders	Automated reminders after 3 days

Platform and Integration Considerations

Choose a platform that integrates with your CRM, document storage, and AML screening tools to minimize manual work.

CRM Integration: Sync declarant records to Salesforce or NetSuite
Cloud Storage: Store copies in Box or Google Drive
Screening Tools: Connect to sanctions/PEP providers

Ensure the chosen platform supports audit trails, secure attachments, and retention controls to meet legal and regulatory requirements.

Timing and When to Request an Updated Declaration

Establish clear triggers and deadlines for collecting or refreshing PEP declarations to keep records accurate and defensible.

Onboarding Request:

Collect at account opening or engagement start

Annual Refresh:

Request updates at least annually for high-risk relationships

Change in Circumstances:

Require immediate update when status changes

Transaction Threshold:

Trigger re-declaration for large-value transactions

Incident Response:

Re-check after adverse media or sanctions hits

Common Pitfalls to Avoid

Incomplete names or inconsistent name formats can block identity verification and require re-submission, delaying onboarding.
Asking for sensitive identifiers like SSN unnecessarily increases privacy risk; request only when legally required for tax or identity verification.
Failing to link the declaration to a signed audit trail leaves the document open to dispute about timing and signer intent.
Not updating declarations after a change in status can result in undetected risks and noncompliance with ongoing monitoring obligations.

Consequences of Incorrect or Missing Declarations

Regulatory Fines: Monetary penalties

AML Investigations: Increased scrutiny and reporting

Business Risk: Contract pauses or terminations

Reputational Harm: Public disclosure impact

Operational Delay: Onboarding holds

Tax Withholding: Backup withholding risk

Real-World Examples of Use

Organizations across sectors collect PEP declarations during onboarding and vendor acceptance to meet compliance requirements and reduce risk.

Optica Ventures

A venture firm required PEP declarations for limited partners

The firm automated collection and screening
This reduced manual reviews and improved audit readiness while preserving investor confidentiality.

Fertility Centers of Illinois

A healthcare provider integrated declarations into patient vendor checks

The practice routed suspicious cases to compliance
Resulting documentation supported internal reviews and HIPAA-consistent retention policies.

Practical Tips for Accurate and Efficient Declarations

Adopt consistent templates and a documented workflow to reduce errors and simplify audits.

Standardize the Form

Use a single, controlled template across the organization and version it for changes. Maintain a documented approval chain and a revocation process for superseded forms.

Limit Sensitive Data

Collect only the identity details required for verification. Avoid storing plaintext SSNs; if required, encrypt and restrict access per data protection rules.

Use Conditional Logic

Show follow-up questions only when PEP or relationship is selected. This reduces signer confusion and ensures the reviewer receives relevant information.

Log Review Decisions

Record compliance conclusions, risk ratings, and any mitigation steps in the file to demonstrate a documented decision-making process for auditors.

eSignature Pricing and Feature Snapshot for PEP Declarations

Comparing entry-level pricing and core features can help choose an eSignature provider. signNow is listed first per comparison conventions.

	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, no credit card required	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No envelope cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Frequently Asked Questions and Troubleshooting

Answers to common questions about completing, signing, and storing Politically Exposed Persons Declaration Forms.

Need help? Contact support

Can this form be signed electronically?
Yes. Electronic signatures are legally valid under the ESIGN Act (15 U.S.C. §7001) and UETA in most states when intent, consent, attribution, and record retention are satisfied.
Is notarization required?
Not generally required for internal PEP declarations, but some states or contract terms may request notarization; check state rules and contract language before requiring notarization.
What if the declarant changes status?
Request an updated declaration immediately upon a change in public office or relationship to ensure ongoing due diligence and support any necessary risk mitigation steps.
How should I store completed forms?
Store signed forms in secure, access-controlled systems with audit trails. For healthcare contexts follow HIPAA retention and security requirements (45 CFR §164.530(j)).
Who should sign for an organization?
The individual PEP or authorized representative should sign. A named compliance officer may also certify receipt, review, and decision in the compliance record.
What steps if a form is incomplete?
Flag the record, notify the declarant for completion, and withhold final account activation or transaction processing until the required fields and identity evidence are provided.

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