Friday, February 8, 2019


This was taken from the account application used by one the largest American broker-dealers; you may want to adapt it for your own specific needs.

"You represent that neither you nor any other person who was an ownership interest in, or authority over, the Account is or has been a Politically Exposed Person, also known as a senior political figure, or any immediate family member or close associate of a senior political political figure, within the meaning of the US Department of the Treasury's Guidance on Enhanced Scrutiny for Transactions that May Involve the Proceeds of Foreign Official Corruption, as a referenced in the USA PATRIOT ACT. If you, any other owner of or authorized person on the Account is or has been such a figure, you agree to disclose that fact to ________________ , and provide the necessary information required by law to open and/or to service your Account.

You also represent that this Account will not be used for any transactions with, or for the benefit of, any person, entity or country subject to sanctions administered by the US Treasury Office of Foreign Assets Control ("OFAC"). "

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