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Declaration Section :

According to the Financial Action Task Force (FATF), “Politically Exposed Persons” (PEPs) are individuals who are/ have been entrusted with a prominent public function. Due to their position and influence, it is recognized that many PEPs are in positions that potentially can be abused for the purpose of committing money laundering (ML) offences and related predicate offences, including corruption and bribery, as well as conducting activity related to terrorist financing (TF). Some examples of PEPs in Trinidad and Tobago are;

› Head of State – the President of the Republic of Trinidad and Tobago

› Head of Government – the Prime Minister

› Senior Members of the Legislature e.g. The Speaker of the House and the President of the Senate

› Senior Politicians e.g. all Members of Parliament, Government Ministers, Mayors , Leader of the Opposition, Chairman and Chief Secretaries of the Tobago House of Assembly, Parliamentary Secretaries

› Senior Government Officials e.g. Permanent Secretaries, Chief Technical Officers, an Ambassador or High Commissioner, Assistant Commissioner of Police or higher rank

› Judicial Officials e.g. Magistrates, Judges of the Supreme Court, Judges of the Industrial Court, Judges of the Caribbean Court of Justice.

› Military Officials – a Lieutenant Colonel or higher rank

› Senior executives of State owned corporations e.g. Members of the Boards of all Statutory Bodies and State Enterprises including those bodies in which the State has a controlling interest

› Senior political party officials e.g. Chairman, Political Leader and Deputy Political Leader of a political party.

› Immediate Family Members who are related to the PEP through birth or marriage such as spouse, parents, siblings or children of that person and the parents, siblings and additional children of the person’s spouse.

› Close associates who are socially or professionally closely connected to a PEP

ARE YOU NOW OR HAVE YOU EVER BEEN A HOLDER OF PUBLIC OR POLITICAL OFFICE IN ANY COUNTRY (LOCAL OR FOREIGN) ? *

ARE YOU OR HAVE YOU EVER BEEN CONNECTED TO ANY “POLITICALLY EXPOSED PERSONS” (LOCAL OR FOREIGN) ? *

BENEFICIARY DETAILS 1:

In the event of death I hereby nominate Ms./Mr./Mrs * to receive any monies accruing to me in the Society, not exceeding Fifty Thousand Dollars ($50,000.00) and the balance to my estate as per Co-Operative Societies Act, Chapter 81:03, Part III, Page 18, Section 41 (3) and Amendment Act No. 23 of 2019 Section 8.

Tel. Contact *
Tel. Contact
Tel. Contact
Date Of Birth *
Personal Email Address *
Marital Status *
Gender: *
Residents: *
Dependents: *
How Many
Nationality: *
Country of Birth: *
Country of Residence: *
Identification No.: *
Relation to members: *
Address *
BENEFICIARY DETAILS 2:
Tel. Contact
Tel. Contact
Tel. Contact
Date Of Birth
Personal Email Address
Marital Status
Gender:
Residents:
Dependents:
How Many
Nationality:
Country of Birth:
Country of Residence:
Identification No.
Relation to members:
Address
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