The Anti Money Laundering Declaration Form is a crucial document required by Indonesian financial institutions and regulated entities to ensure compliance with the country's AML regulations, particularly Law No. 8 of 2010 and OJK Regulation No. 12/POJK.01/2017. This form is typically required when establishing new business relationships, conducting significant transactions, or updating customer due diligence information. It contains detailed declarations about the source and legitimacy of funds, beneficial ownership information, PEP status, and other AML-related matters. The document helps institutions meet their regulatory obligations while providing a standardized way for customers to declare their compliance with AML requirements. It serves as both a risk assessment tool and a legal record of the declarant's statements regarding their financial activities and AML compliance commitments.
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1. Declarant Information: Full identification details of the person or entity making the declaration, including name, address, and identification numbers
2. Source of Funds Declaration: Declaration regarding the legitimacy and origin of funds involved in transactions
3. Purpose of Transaction: Statement describing the intended purpose and nature of business relationship or transaction
4. Beneficial Ownership Declaration: Declaration of ultimate beneficial owners if applicable, especially for corporate entities
5. PEP Status Declaration: Declaration whether the declarant is a Politically Exposed Person or related to one
6. Criminal Record Declaration: Declaration regarding any money laundering or financial crime related convictions or ongoing investigations
7. Compliance Commitment: Declaration of commitment to comply with all applicable AML laws and regulations
8. Truth and Accuracy Statement: Declaration that all information provided is true and accurate
9. Signature and Date: Space for declarant's signature, date, and witness signature if required
1. Corporate Structure Details: Additional section for corporate entities to declare their ownership structure and control
2. International Transactions: Special declarations for entities involved in international transactions or cross-border transfers
3. High-Risk Business Activities: Additional declarations for entities operating in high-risk industries or jurisdictions
4. Third Party Relationships: Declarations regarding relationships with third parties who may be involved in transactions
5. Tax Compliance Declaration: Additional declarations regarding tax compliance status and obligations
1. Appendix A - Supporting Documents Checklist: List of required supporting documents to be submitted with the declaration
2. Appendix B - Beneficial Ownership Structure Chart: Visual representation of ownership structure for corporate entities
3. Appendix C - Risk Assessment Form: Detailed risk assessment questionnaire if required by the receiving institution
4. Appendix D - Transaction History Summary: Summary of relevant historical transactions if applicable
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