POLITICALLY EXPOSED PERSON (PEP)

SELF-DECLARATION FORM

Neteller, as an authorised Electronic Money Issuer in the United Kingdom, is obligated to verify
those clients who are classified as Politically Exposed Person (PEP). In that regard please mind
that the information you provide must be as complete and accurate as possible. Any information
you provide us will only be used in accordance to the applicable data protection regulation.

Please read carefully the definition below:

We designate any person who meets any of the following criteria as a PEP:

 An individual who holds, or has held within the preceding 18 months, a political function on
a national level or on a supranational or international level.
 An immediate family member of someone meeting the criteria above.
 A known close associate of someone meeting the criteria above.

Examples of prominent public functions, which we would always consider to be PEPs, include but
are not limited to the following:

 Heads of state and heads of government

 Chancellor, Chief of Staff; or one of these titles (or similar) with a prefix such as Deputy
(Secretary), Assistant, Lieutenant, or Vice
 Members of supreme courts, constitutional courts, or other high-level judicial bodies
 Members of courts of auditors or of the boards of central banks
 Ambassadors, chargés d’affaires, Acting Chief of Mission, Deputy Head of Mission, High
Commissioner and high-ranking officers in the armed forces. High-ranking military officers
include but are not limited to generals, admirals, and field marshals.
 Members of the administrative, management, or supervisory board of state-owned
enterprises.
 Members of national legislative bodies
 Members of European Community Institutions
 High-ranking officials of the United Nations or other supranational bodies of comparable
importance
We define the immediate family members, we would always consider to be PEPs:

 Spouse
 Partner, including a person considered by national law applicable to the PEP to be
equivalent to a spouse
 Children, including stepson and stepdaughter (including sons- and daughters-in-law)
 Spouses or partners of children
 Parents
We define associates, we would always consider to be PEPs:

 Any individual known to have joint beneficial ownership of a legal entity or legal
arrangement, or any other close business relations, with a PEP.
 Any individual who has sole beneficial ownership of a legal entity or legal arrangement
which is known to have been set up for the benefit of a PEP

Please complete the following information, and select the relevant boxes:

I, ______________________________________________, ____________________________
NAME OCCUPATION

of__________________________________________________________________________
RESIDENTIAL ADDRESS

I am a Politically Exposed Person (PEP) as defined above Yes ☐/ No ☐

I confirm that the information in the present Declaration is true and accurate ☐

_________________________________ ____________________________
DATE E-SIGNATURE

Please E-Sign and reply directly to the email you received.

Please be advised if you prefer to print, sign and scan the document this is acceptable.