Enhanced Due Diligence Escalation Form (Sample)

Date of Report:    

Assigned AML Risk:

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Staff Information

Name of Staff Submitting the Escalation:      

  • Department:
  • Contact Phone Number:
  • Contact Email:

Name of Compliance Officer Receiving the Escalation:

  • Department:
  • Contact Phone Number:
  • Contact Email:           

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Customer Information

  • Type of Entity (Individual, Corporation, LLP, etc.):
  • Affiliate / Subsidiary of Existing Customer?:
  • Name of Affiliate / Parent Company Customer:

Customer (Individuals):

  • Name:
  • Address:
  • Domicile:
  • DOB:
  • ID Number (Social Security or Passport):
  • Phone Number:
  • Gender:

Customer (Legal Entity):

  • Name of Individual(s) Requesting Account Opening:
  • Title:
  • Address:
  • Domicile:
  • Phone Number (and Extension):
  • Gender:

Name of Individual(s) Requesting Account Opening:

  • Title:
  • Address:
  • Domicile:
  • Phone Number:

Account Information

  • Type of Account / Service:
  • Specify Any Pending Deposits:

List of Documentation Attached to EDD Escalation Form Memo

  1. ________________________________________________
  2. ________________________________________________
  3. ________________________________________________
  4. ________________________________________________
  5. ________________________________________________

High Risk Factors

(Detailed explanation of the factors contributing to the assigned risk)

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Monitoring Plan to Support Approval of EDD Escalation Form Memo

(If high risk client is accepted as a customer, what monitoring or risk mitigating activities should be enforced?)

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Additional Information to Support EDD Escalation Review

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