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Correspondents Registration
I. Company
* Name of the company:
   ID/ Registration Number:
   Address:
   City:
   Location (Country):
   Number of Employees:
   Year of Establishment:
II. Contact Information
* Contact Person/s:
   Phone Number:
   Fax Number:
* Email ID:
   Company Website:
III. Share Holding Pattern
Full Name Nationality Coutry of Residence ID No. Share%
IV. Legal Representation (Board of Directors and Officers)
Name Designation Nationality Coutry of Residence
V. Services Offered (Money Transfer, Issue of Money Orders, Check Cashing etc.)
VI. Licenses
Country State Services Licenced For Valid Upto
VII. Compliance Officer
Name:
Phone Number:
Email ID:
VIII. Regulatory Authorities
Please list below the Statutory Agencies/ Authorities which exercise regulatory control over your company in your jurisdiction/ country
IX. Please provide the following information.
1 Does your company have a management-approved and documented policy, program, and procedures for Anti-Money laundering and Terrorism Financing?  Yes  No
2 Has your company a designated Compliance Officer?  Yes  No
3 Is there an arrangement to independently test your Company's Compliance program by an professional./ Auditor, and whether such testing is carried out regularly?  Yes  No
4 Has your company an ongoing Compliance training for its officers, employees, and agents?  Yes  No
5 Has any of the territories/ countries in which your company operates been any time listed by FATF in its NCCT list (Non-Cooperating Countries and Territories), or as a jurisdiction displaying strategic deficiencies in its anti-money laundering and anti-terrorism financing regimes?  Yes  No
6 Has your company a documented Know Yor Customer (KYC) and Enhanced Due Diligence (EDD) program for its customers, clients, and partners, and correspondents?  Yes  No
7 Is there a OFAC (US Office of Foreign Assets Control List) filter enabled in your organizations transaction processing system?  Yes  No
8 Does your company provide any kind of service to shell companies or shell banks?  Yes  No
9 If your response to any of the questions below is 'Yes', please attach the details and current status of the cases.  Yes  No
I Has your company been subject to any regulatory action or penalty in the past?  Yes  No
II Has your company been subject to any action by enforcement agencies of your country 9the country in which your company is located)?  Yes  No
III Is there any outgoing regulatory action against your company at present?  Yes  No
IV Has your company been penalized by bankruptcy or any court order at any time?  Yes  No
V Has your company's license been revoked or suspended by any regulatory authority in your country?  Yes  No
10 Do you have a record keeping Policy? (Mention the record retention period as per your policy: years)  Yes  No
11 Any other information you wish to provide:  
X. Please attach copies of the following documents.
1. Memorandum and articles of association or equivalent document:
2. Licenses and Registrations:
3. Latest FinCEN registration (Acknowledgement from FinCEN, USA):
4. Latest audited financial statements:
5. BSA and AML policy manual:
6. Record keeping policy manual (or extracts):
7. KYC/ EDD policy manual (or extracts):
 I certify the above details provided by us are true and reflect the correct information about our company.
Authorized Signatory (Name):
Designation:
Date:
Place:
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