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
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- ________________________________________________
- ________________________________________________
- ________________________________________________
- ________________________________________________
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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