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UBO Affidavit Form

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UBO AFFIDAVIT FORM

Affiant Name:   Title:

Entity Name:   Entity Type:

Jurisdiction of Formation:   Registration/Tax ID:

RECITALS

WHEREAS, the Affiant is the duly authorized officer or agent of the Entity identified above and is authorized to make this affidavit on behalf of the Entity; and

WHEREAS, financial institutions and other regulated parties require identification of ultimate beneficial owners and persons exercising control over legal persons for purposes of compliance with applicable anti-money laundering and know-your-customer obligations; and

WHEREAS, the Entity is providing the representations and disclosures in this affidavit to the Recipient set forth below for the purpose of identifying ultimate beneficial owner(s) and persons exercising control.

Recipient Name:

NOW THEREFORE, in consideration of the foregoing recitals and intending to be legally bound, Affiant hereby certifies, represents and warrants as follows:

1. DEFINITIONS

For purposes of this Affidavit: "Ultimate Beneficial Owner" or "UBO" means any natural person who, directly or indirectly, (a) owns or controls, through ownership interest of more than 25% of the equity interests of the Entity, or (b) otherwise exercises ultimate effective control over the Entity through other means, including voting, personal connections, agreements, or other control mechanisms.

2. DISCLOSURE OF ULTIMATE BENEFICIAL OWNERS

The Entity discloses the following natural persons who are UBOs, owners of more than 25% of the Entity, or who otherwise exercise ultimate control. If no individual meets the ownership threshold, identify the senior managing official who exercises control.

Beneficial Owner 1

Beneficial Owner 2

Beneficial Owner 3 (if applicable)

3. ATTESTATION

The Affiant affirms, under penalty of perjury and to the best of their knowledge and belief, that the information provided in this Affidavit is true, complete and correct. The Affiant further certifies that the Affiant is authorized to provide the foregoing information on behalf of the Entity and that the Entity will promptly notify the Recipient in writing of any material change in the ownership or control information previously provided.

The Affiant acknowledges that the Recipient may rely upon this Affidavit and may verify the information provided herein with relevant third parties and governmental authorities. The Affiant consents to such verification and to any lawful retention of these records by the Recipient.

4. REPRESENTATIONS AND WARRANTIES

The Affiant represents and warrants that (a) no material fact required to be disclosed has been omitted; (b) no false statements have been made; and (c) the individuals identified as UBOs are accurately described with regard to their ownership interest and control. The Affiant further warrants that the Entity is not established for the purpose of concealing ownership or facilitating unlawful activity.

5. NOTICES

All notices under this Affidavit shall be in writing and delivered to the addresses set forth below or to such other address as either party may designate by notice in accordance with this paragraph.

6. AMENDMENTS; WAIVER; COUNTERPARTS

This Affidavit may be amended only by a written instrument executed by both the Affiant on behalf of the Entity and the Recipient. No waiver of any provision of this Affidavit shall be effective unless in writing and signed by the party granting such waiver. This Affidavit may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument.

7. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This Affidavit shall be governed by and construed in accordance with the laws of the jurisdiction of the Entity's primary place of business without regard to conflict of laws principles. This Affidavit constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior understandings and agreements, whether written or oral. If any provision of this Affidavit is held to be invalid or unenforceable, the remaining provisions shall continue in full force and effect.

8. ADDITIONAL INFORMATION

CERTIFICATION

I, the undersigned Affiant, certify under penalty of perjury under the laws of the governing jurisdiction that the information contained in this Affidavit is true, correct and complete to the best of my knowledge and belief. I acknowledge that knowingly providing false information may subject me and the Entity to civil or criminal penalties.

Affiant Printed Name:

By:

Date:

Recipient Printed Name:

By:

Date:

Enter text✕

What the UBO Affidavit Form Is

A UBO Affidavit Form documents the identity and ownership of the Ultimate Beneficial Owner(s) of an entity. It is commonly requested by banks, payment processors, and compliance teams to meet customer identification and anti‑money laundering obligations, and to verify who ultimately controls or benefits from a legal entity. The affidavit typically lists legal names, ownership percentages, nature of control, tax identification numbers, and supporting ID, and may be notarized or accompanied by a corporate resolution depending on the recipient's requirements.

Why organizations request a UBO Affidavit

A UBO Affidavit clarifies ownership and control, helps meet AML/CIP requirements, and reduces onboarding delays by providing standardized, auditable information.

Why organizations request a UBO Affidavit

Who typically completes or requests this form

Typical requesters include financial institutions, payment providers, corporate registrars, and in-house legal or compliance teams when verifying beneficial ownership.

  • Bank compliance officers verifying beneficial ownership during account opening or high‑risk reviews.
  • Treasury and payments teams collecting vendor or customer ownership details for onboarding.
  • Company officers (CEO, CFO, company secretary) providing sworn statements on behalf of the legal entity.

The form is completed by authorized company representatives or owners who can attest to ownership details and sign under penalty of perjury where required.

Core sections to include in a professional UBO Affidavit Form

A complete UBO Affidavit combines entity identifiers, a clear ownership table, attestations, signature blocks, and supporting document references to satisfy typical compliance and audit requirements.

Entity ID

Full legal entity name, jurisdiction of formation, and taxpayer identification number so recipients can match the affidavit to corporate records and tax filings.

Beneficial Owners

A table listing each UBO with full legal name, date of birth, residential address, ownership percentage, and role or nature of control for precise identification.

Ownership Details

Describe how ownership is held (direct, indirect, nominee), chain of ownership if applicable, and any entities that act as intermediaries or trustees.

Attestation

A clear sworn statement declaring the truth of the information, including language about penalties for false statements and the declarant's relationship to the entity.

Signature Block

Name, title, signature, and signature date for the authorized signatory; include notary acknowledgment or witness lines if required by recipient or state law.

Supporting Docs

References to attached documents such as government ID copies, corporate resolutions, amended articles, or trust instruments used to verify ownership claims.

Step-by-step: filling and delivering a UBO Affidavit

Follow these sequential steps to complete the affidavit correctly and minimize processing delays.

  • 01
    Prepare entity data: Gather formation documents and EIN for accurate entity identification.
  • 02
    List UBOs: Enter each beneficial owner with required personal and ownership details.
  • 03
    Attach proof: Include copies of government IDs and corporate resolutions as supporting documents.
  • 04
    Sign and notarize: Have an authorized officer sign; notarize if the recipient requires an acknowledgement.

Configure an online UBO affidavit workflow

When automating the form, configure fields and routing so the document collects required data and evidence before final submission.

Field Configuration
Legal Entity Name Required text field; validation against corporate registry preferred
Ownership Table Repeating group with name, DOB, address, percentage fields
ID Upload File upload restricted to PDF/JPG; limit file size to 10 MB
Signature eSignature field with date and optional notary attachment

Where to send the completed UBO Affidavit

Choose the destination based on who requested the affidavit and their compliance workflow to ensure the record is accepted without further steps.

  • Financial institution: Submit to the bank or payment provider that requested the affidavit for account onboarding.
  • Corporate records: Keep a signed copy with company minute books or corporate secretary records.
  • Legal counsel: Provide to outside counsel when used for corporate transactions or due diligence.
  • Regulatory filings: Include only if a regulator or filing system explicitly requires the affidavit as part of a submission.

Digital signing and eSubmission considerations

Confirm recipient acceptance of electronic signatures and whether notarization or witness lines are required before eSubmission.

  • File formats: PDF and DOCX are widely accepted
  • Authentication: Email, SMS, or stronger KBA methods
  • Integrations: Connectors to CRM or document repositories

Typical timing and when to provide the affidavit

Timing depends on the requestor; respond promptly to avoid account holds, but know common triggers and deadlines.

Account opening requests:

Provide the affidavit at the time of new account onboarding to avoid processing delays.

Periodic reviews:

Respond within the timeframe specified in the review notice, often 10–30 days.

Regulatory inquiries:

Deliver immediately when requested by regulator or law enforcement with specified deadlines.

Transaction closings:

Supply before closing if required for escrow, escrow waivers, or payment approvals.

Upon audit:

Provide within the auditor's requested period to support due diligence and reporting.

Common mistakes that cause rejections or delays

  • Submitting partial ownership totals or missing owners so ownership percentages do not add to 100% and prompt follow-up inquiries.
  • Using inconsistent names or variations (initials, shortened names) that do not match government IDs or formation documents.
  • Failing to attach required supporting documents such as government ID, corporate resolutions, or trust instruments when ownership is indirect.
  • Not verifying whether the recipient requires a notarized signature or specific wording in the attestation clause, causing nonacceptance.

Penalties and risks for incorrect or false affidavits

False statement exposure: Civil and criminal penalties may apply for knowingly false affidavits
AML reporting: Inaccurate UBO data can trigger suspicious activity reports
Account restrictions: Banks may freeze accounts pending verification
Contract invalidity: Certain transactions may be delayed or voided
Tax implications: Incorrect TINs can lead to backup withholding
Regulatory fines: Issuers and companies face enforcement penalties

Essential data elements UBO Affidavits should capture

Full legal name: Owner's complete legal name
Date of birth: MM/DD/YYYY format
Address: Street, city, state, ZIP
Ownership percent: Numeric percentage, two decimals
Tax ID: EIN or SSN/TIN as applicable
ID document: Passport or government ID type

Comparison: eSignature vendors for signing and storing UBO Affidavits

Basic vendor capabilities and starting prices are shown below. Confirm feature availability and compliance options directly with each vendor before selecting a solution.

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 by plan Varies by plan Varies by plan Varies by plan
Bulk Send Yes Yes Yes Yes Varies
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes (BAA required) Varies Varies No No

Example scenarios where a UBO Affidavit is used

Practical examples show common triggers for preparing a UBO Affidavit and what recipients typically expect to see.

Case Study 1

A small business opens a new bank account and is asked to confirm owners and control

  • The business provides a signed affidavit listing two UBOs with ID copies
  • The bank accepts the affidavit and clears the account for ACH and wire transfers after verification, avoiding account holds.

Case Study 2

A real estate closing requires disclosure of beneficial owners for an entity purchaser

  • The title company requests a UBO Affidavit with ownership percentages and a corporate resolution
  • Providing the affidavit with notarized signature and supporting formation documents enables the closing without deferred underwriting.

Tips to complete UBO Affidavits accurately and efficiently

Follow these best practices to reduce follow-up requests and ensure the affidavit meets typical compliance expectations.

Verify names and IDs
Compare names exactly with government IDs and formation documents; mismatches are the most common cause of rejections and rework.
Aggregate ownership
When ownership is indirect, show the full chain and how percentages aggregate to reveal true beneficial interests.
Use clear attestations
Include explicit sworn language about completeness and truthfulness, and state any legal basis for penalties on false statements.
Plan for notarization
Check recipient notarization requirements in advance; remote online notarization may be accepted in many states but confirm before eSigning.

Frequently asked questions about UBO Affidavits

Answers to common questions about validity, signatures, notarization, updates, and recordkeeping for UBO Affidavits.


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