BFIU Circular Letter No. 04: Issuance of Uniform KYC Profile Form for Insurance Companies

Bangladesh Financial Intelligence Unit Bangladesh Bank Head Office Dhaka Website: www.bfiu.gov.bd 05 Ashwin, 1424 BFIU Circular Letter No. 04/2017 Date: ------------- 20 September, 2017 Chief Executive Officer / Managing Director All Insurance Companies operating in Bangladesh Dear Sir, Regarding the issuance of the Uniform KYC Profile Form for Insurance Companies/Corporations.

In light of the decision to issue the Uniform KYC Profile Form for Insurance Companies/Corporations to combat Money Laundering and Terrorist Financing risks, under the powers granted by Section 23(1)(d) of the Money Laundering Prevention Act, 2012 and Section 15(1)(d) of the Anti-Terrorism Act, 2009, the aforementioned Uniform KYC Profile Forms (applicable to Life/Non-Life Insurance Companies/Corporations) are hereby issued.

2. The issued Uniform KYC Profile Forms may be printed in either Bengali or English.

3. Insurance Companies/Corporations must duly fulfill their responsibility to collect and preserve accurate and complete customer information in accordance with Section 25(1)(a) of the Money Laundering Prevention Act, 2012.

4. The issued Uniform KYC Profile Forms must be implemented by January 1, 2018.

I would be grateful for your acknowledgment.

Yours faithfully, (Deb Prasad Debnath) General Manager Phone: 9530118 Copy No. - BFIU(Insurance)- 01/2017 Date: Noted Copies are sent to the following for information and necessary action (in order of seniority):

1. Chairman, Insurance Development and Regulatory Authority (IDRA), ESC Tower, (8th Floor), 37/A Dilkusha B/ A, Dhaka.
2. Secretary to the Governor, Bangladesh Bank, Head Office, Dhaka.
3. Private Secretary to the Governor, Bangladesh Bank, Head Office, Dhaka.
4. Additional Director attached with the Deputy Governor and Head of BFIU, Bangladesh Bank, Head Office, Dhaka.
5. Personal Assistant to the Director and Deputy Head of BFIU, Bangladesh Bank, Head Office, Dhaka.
6. Chairman, Bangladesh Insurance Association, Hosain Tower (9th Floor), Box Culvert Road, New Market, Dhaka.
7. Chairman, Bangladesh Insurance Forum, People's Insurance Building (2nd Floor), 36 Dilkusha B/ A, Dhaka. (Md. Golam Kabir) Deputy Director Phone: 255665001-20/20280 E-mail: md.golam.kabir@bb.gov.bd

Customer Identification Related Form (KYC Profile) (Applicable in the case of Insurance Policy for Individual Property) (Non-Life Insurance)

1. Name/Category of Insurance Policy: Policy Reference No./Policy No.: Type/Description of Insured Property: Valuation of Property:
2. Customer Identification: Customer Name: Date of Birth: Father's Name: Mother's Name: Spouse's Name: Customer's Nationality: Telephone (Home): Telephone (Office): Mobile: Fax: E-mail:
3. Identity Document: Copy Taken a) National ID No.: -------------------------------------------------------- Yes No b) Passport No.: -------------------------- Expiry: ------------------- Yes No c) Birth Registration Certificate No.: --------------------------------------------------- Yes No d) E-TIN IAN (E-TIN) (if any): ----------------------------------------- Yes No e) Driving License No.: ----------------------- Expiry: ------------------ Yes No f) Others (to be specified): ------------------------------------ Yes No [From documents listed in serial numbers a to f, one document must be provided mandatorily. However, in the case of opening a policy by providing a Birth Registration Certificate, in addition to the Birth Registration Certificate, any other identity document along with a photograph of the policyholder must be provided. If there is no identity document with a photograph, a certificate of identity issued by a respected person of society acceptable to the insurer must be provided. Such identity document or certificate must be accompanied by a photograph of the policyholder (with verification on the upper side of the photograph). Furthermore, to ensure customer identification, each insurance institution may collect additional documents and information beyond those listed in serial numbers d to f and the information mentioned in this form, subject to the institution's satisfaction.]
4. Permanent Address:

1 "Respected person" means Members of Parliament, Mayor, Deputy Mayor and Councilors of City Corporations, Gazetted Officers of Grade 9 and above of the National Pay Scale, Teachers of Public Universities, Chairman and Vice-Chairman of Upazila Parishads, Chairman of Union Parishads, Mayor and Municipal Councilors of Pourashavas, Professors of Private Universities, Principals of Private Colleges, Head Teachers of Private High Schools, Editors of National Daily Newspapers, Notaries Public, Officers of Grade 7 or above of the National Pay Scale in semi-government/autonomous/state organizations, and Officers of Grade 9 and above of the National Pay Scale in Bangladesh Bank.

Date: Photo of Insurance Customer

5. Residential/Current Address:
6. Customer's Profession (Detailed): Professional Address (Name/Designation/Address):
7. Source of Funds: Method of Verification of Source of Funds:
8. Premium Payment Method: Monthly Quarterly Half-Yearly Yearly One-Time
9. Amount of Premium:
10. Mode of Premium Payment: (a) Bank (with details) (b) Cash
11. Risk Assessment of Insurance Customer: Low High [In the remarks section, the customer's risk must be mandatorily considered based on specific (channel-based) considerations. In determining the customer's risk, the customer's profession should be analyzed in detail; considering aspects such as the nature of the business, amount of funds, area of business, size of business, actual beneficiary of accounts, etc., the customer should be classified as having high or low risk. In the case of employment, detailed information should be obtained similarly; especially considering the nature and scope of duties, risk should be determined. If the customer is high-risk, regular monitoring must be conducted.]
12. Remarks:

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Signature of Officer/Relationship Manager concerned with the policy Signature of Approving Officer (Seal and Date) (Seal and Date)

Customer Identification Related Form (KYC Profile) (Applicable in the case of Insurance Policy for Non-Individual Property) (Non-Life Insurance)

1. Name/Category of Insurance Policy: Policy Reference No./Policy No.:

2. Name of the Policyholder Institution:

3. Address of the Institution:

4. Correspondence Address:

5. Nature of Business:

6. Copy of Registration Certificate Taken: Yes No

7. Registration Authority: Date and Place of Issue:

8. Copy of Trade License (if applicable) Taken: Yes No

9. Copy of E-TIN (E-TIN) (if any) Taken: Yes No

10. Name of Proposed Insurer:

11. Amount of Premium:

12. Source of Funds:

13. Premium Payment Method: Monthly Quarterly Half-Yearly Yearly One-Time

14. Name of Person(s) Authorized to Operate the Policy: Name: Father's Name: Mother's Name: Spouse's Name: Profession: Date of Birth: Current Address: Permanent Address: Nationality: National ID Number: Telephone (Home): Telephone (Office): Mobile: E-mail:

15. Beneficial Owner of the Policy: (Detailed information of controlling shareholders and single shareholders holding 20% or more in the case of companies) Date:

Name Relationship 16. If the proposed insurance is related to Import/Export, attach the following details: 17. Mode of Premium Payment: (a) Bank (with details) (b) Cash 18. Risk Assessment of Policyholder Institution: Low High

[In the remarks section, the risk of the policyholder institution must be mandatorily considered based on specific (channel-based) considerations. In determining the institution's risk, considering aspects such as the nature of the business, amount of funds, area of business, size of business, actual beneficiary of accounts, etc., the institution should be classified as having high or low risk. If high-risk, regular monitoring must be conducted.] 19. Remarks:

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Signature of Officer/Relationship Manager concerned with the policy Signature of Approving Officer (Seal and Date) (Seal and Date)

Name of Insurance Name of Bank related to Import/Export LC Number and Date Value of LC and Currency Unit Importer or Exporter Country Name of Goods

Customer Identification Related Form (KYC Profile) (Applicable in the case of Life Insurance Policy for Individuals) (Life)

1. Name/Category of Insurance Policy: Policy Reference No./Policy No.:

2. Customer Identification: Customer Name: Date of Birth: Father's Name: Mother's Name: Spouse's Name: Nationality: Telephone (Home): Telephone (Office): Mobile: Fax: E-mail:

3. Identity Document: Copy Taken a) National ID No.: -------------------------------------------------------- Yes No b) Passport No.: -------------------------- Expiry: ------------------ Yes No c) Birth Registration Certificate No.: --------------------------------------------------- Yes No d) E-TIN IAN (E-TIN) (if any): ----------------------------------------- Yes No e) Driving License No.: ----------------------- Expiry: ------------------ Yes No f) Others (to be specified): ------------------------------------ Yes No [From documents listed in serial numbers a to f, one document must be provided mandatorily. However, in the case of opening a policy by providing a Birth Registration Certificate, in addition to the Birth Registration Certificate, any other identity document along with a photograph of the policyholder must be provided. If there is no identity document with a photograph, a certificate of identity issued by a respected person of society acceptable to the insurer must be provided. Such identity document or certificate must be accompanied by a photograph of the policyholder (with verification on the upper side of the photograph). Furthermore, to ensure customer identification, each insurance institution may collect additional documents and information beyond those listed in serial numbers d to f and the information mentioned in this form, subject to the institution's satisfaction.]

4. Permanent Address:

5. Residential/Current Address:

6. Customer's Profession (Detailed):

1 "Respected person" means Members of Parliament, Mayor, Deputy Mayor and Councilors of City Corporations, Gazetted Officers of Grade 9 and above of the National Pay Scale, Teachers of Public Universities, Chairman and Vice-Chairman of Upazila Parishads, Chairman of Union Parishads, Mayor and Municipal Councilors of Pourashavas, Professors of Private Universities, Principals of Private Colleges, Head Teachers of Private High Schools, Editors of National Daily Newspapers, Notaries Public, Officers of Grade 7 or above of the National Pay Scale in semi-government/autonomous/state organizations, and Officers of Grade 9 and above of the National Pay Scale in Bangladesh Bank.

Photo of Insurance Customer Date:

Professional Address (Name/Designation/Address): 7. Source of Funds: 8. Method of Verification of Source of Funds: 9. Premium Payment Method: Monthly Quarterly Half-Yearly Yearly One-Time 10. Amount of Premium:

11. Mode of Premium Payment: (a) Bank (with details) (b) Cash
12. Details of Nominee: Name of Nominee: Relationship: Father's Name: Mother's Name: Spouse's Name: Profession: Date of Birth: Current Address: Permanent Address: National ID No. (with copy): Telephone (Home): Telephone (Office): Mobile: Fax: E-mail: (If there are multiple nominees, details and percentage of all nominees with photographs must be mentioned)
13. Risk Assessment of Insurance Customer: Low High [In the remarks section, the customer's risk must be mandatorily considered based on specific (channel-based) considerations. In determining the customer's risk, the customer's profession should be analyzed in detail; considering aspects such as the nature of the business, amount of funds, area of business, size of business, actual beneficiary of accounts, etc., the customer should be classified as having high or low risk. In the case of employment, detailed information should be obtained similarly; especially considering the nature and scope of duties, risk should be determined. If the customer is high-risk, regular monitoring must be conducted.]
14. Remarks:

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Signature of Officer/Relationship Manager concerned with the policy Signature of Approving Officer (Seal and Date) (Seal and Date)

Photo of Insurance Customer Verified by Nominee

Customer Identification Related Form (KYC Profile) (Applicable in the case of Group Insurance Policy) (Life)

1. Name/Category of Insurance Policy: Policy Reference No./Policy No.:

2. Name of the Institution for Proposed Insurance Policy:

3. Address of the Institution:

4. Correspondence Address:

5. Nature of Business:

6. Copy of Registration Certificate Taken: Yes No

7. Registration Authority: Date and Place of Issue:

8. Copy of Trade License (if applicable) Taken: Yes No

9. Copy of E-TIN (E-TIN) (if any) Taken: Yes No

10. Name of Proposed Insurer:

11. Amount of Premium:

12. Source of Funds: Method of Verification of Source of Funds:

13. Premium Payment Method: Monthly Quarterly Half-Yearly Yearly One-Time

14. Details of Persons Related to Group Insurance Policy: (If necessary, the following details may be attached separately) Name: Father's Name: Mother's Name: Spouse's Name: Profession: Date of Birth: Current Address: Permanent Address: Nationality: National ID Number: Telephone (Home): Telephone (Office): Mobile: E-mail:

15. Beneficial Owner of the Policy: Date:

16. Duration of Insurance Contract:

17. Name and Address of Agent (if applicable):

18. Mode of Premium Payment: (a) Bank (with details) (b) Cash

19. Risk Assessment of Policyholder Institution: Low High [In the remarks section, the risk of the policyholder institution must be mandatorily considered based on specific (channel-based) considerations. In determining the institution's risk, considering aspects such as the nature of the business, amount of funds, area of business, size of business, actual beneficiary of accounts, etc., the institution should be classified as having high or low risk. If high-risk, regular monitoring must be conducted.]

20. Remarks:

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Signature of Officer/Relationship Manager concerned with the policy Signature of Approving Officer (Seal and Date) (Seal and Date)