Individual KYC – Sesiro Insurance Co,

SUBMIT INDIVIDUAL KYC

Please use the below latest form for Individual KYC

FORM LAST COMPLETED IN

IDENTITY DETAILS

Prefix

First Name

Middle Name

Last Name

National ID /Passport Number *

Date of Birth *

Nationality *

GenderMaleFemale

Botswana Citizen / Permanent Resident? *

Postal Address

Physical Address

Village/ Town/ City

Telephone (Work) *

Telephone (Home)

Mobile *

Fax

Email Address *

EMPLOYMENT

Name Of Employer *

Occupation *

Place of Work *

Are you a PIP?

Are you closely related to PIP?

PROOF ADDRESS

Proof of address Document *Please submit the latest of any of the following valid documents (Please tick submitted Document)

Attsch Proof of Address Document *

Drag and Drop (or) Choose Files

- supporting documents -

BANKING DETAILS

Account Name *

Account Number *

Bank *

Branch Name *

Branch Code *

State nature of business if funds received from sources other than salary:

ANTI-MONEY LAUNDERING AND COUNTER TERRORIST FINANCING REQUIREMENTSIn accordance with the Financial Intelligence Regulations, the following documents should be provided for verification: • Identification document e.g. certified copy of I.D / passport and worker’s permit for foreigners. • Source of funds/proof of income or employer confirmation letter. • Proof of Address eg: latest of either telephone bill, electricity bill, water bill or lease agreement, affidavit or tribal authority letter or letter from employer. • If acting on behalf of another, the ID card of that other person and authority to act on behalf of the other person.

ACKNOWLEDGEMENTBy signing below, I agree and voluntarily consent to Sesiro's processing of the provided Information for the purposes of insurance services and any ancillary services related to insurance operations in general and I give Sesiro permission to do so and any personal data (including sensitive personal data) will be processed in accordance with Sesiro's privacy policy available on its website and I further understand that I am free to withdraw my consent on written notice to Sesiro, on legitimate grounds which are reasonable and compelling. I agree that the Information may be disclosed by Sesiro to third parties, including Sesiro's affiliates, service providers and associates (some of which may be located outside of Botswana).

DECLARATION *

I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief, and I undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be liable for it.

PROMINENT INFLUENTIAL PERSON (PIP) SELF DECLARATION

This questionnaire aims to identify PIPs in accordance with the Financial Intelligence Act, 2022 Regulation, to satisfy the Customer Due Diligence (KYC) requirements.

2. Are you currently in any of the following positions:

A Councilor

A Kgosi

A Senior Executive of a private entity of <1 million turnover

A Senior Executive of a public body

A Senior Executive of a political party

Senior Executive of international organisations operating in Botswana

DEFINITIONS

Prominent Influential Person (PIP) - a person entrusted with public functions within Botswana or by a foreign country, his or her close associates or immediate member of the family or international organisation.

Senior executive of a political party - means any person who is the president, vice-president, chairperson, deputy chairperson, secretary or treasurer of such political party or who is a member of the committee or governing body thereof, or who holds in such political party any office or position similar to any of those mentioned above.

Senior executive of a private entity - means a director, controlling officer, partner or any person who is concerned with the management of a private entity’s affairs.

Senior executive of a public body - means a senior officer of an organisation, establishment, or body created by or under any enactment. It includes any company in which the Government has equity or shares or any organisation or body where public money is used.

OR download the attached form and complete for Individual KYC submission

KYC Individual

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