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AML/KYC Compliance Form for Credit Intermediation

Credit Intermediation and Related Activities · NAICS 522 · AML/KYC Compliance Form

This AML/KYC Compliance Form is specifically designed for credit intermediation businesses—such as mortgage brokers, credit brokers, and loan facilitators—that are not traditional banks but still have obligations under the Bank Secrecy Act (BSA) and USA PATRIOT Act. This form helps you collect essential customer information to verify identities, assess risk, and comply with anti-money laundering (AML) regulations. It includes sections for Customer Identification Program (CIP), Customer Due Diligence (CDD), beneficial ownership, and risk rating, ensuring you meet FinCEN expectations. Use this form as part of your new customer onboarding to protect your business from financial crime and regulatory penalties.

When you need this document

When onboarding a new individual or business client for credit intermediation services, such as mortgage brokerage or loan facilitation.
When a client's circumstances change significantly, such as a new source of funds or a change in beneficial ownership, triggering a need for updated due diligence.
When a client is classified as higher risk (e.g., PEP, unusual transaction patterns) and requires enhanced due diligence.
When renewing or updating client files as part of your annual AML compliance review.
When a regulatory examiner requests evidence of your customer due diligence process.

What the generated draft includes

Customer Identification Program (CIP) data fields for name, date of birth, address, and ID verification.
Customer Due Diligence (CDD) questions on purpose of account, source of funds, and expected activity.
Beneficial Ownership section for entities, including 25% owners and control persons.
Politically Exposed Person (PEP) screening and risk rating assessment.
Certification and consent clause for verification and OFAC screening.
Compliance officer sign-off and verification documentation section.

Frequently asked questions

Who is required to complete this AML/KYC form?

Any new customer seeking credit intermediation services—whether an individual or a business entity—must complete this form. This includes mortgage applicants, borrowers, and business owners seeking commercial loans or credit facilitation.

How does this form help with regulatory compliance?

This form aligns with the Bank Secrecy Act and USA PATRIOT Act requirements by collecting key customer identification and due diligence information. It also supports FinCEN's Customer Due Diligence rule, including beneficial ownership identification, which is critical for non-bank financial institutions.

Is this form a substitute for a full AML compliance program?

No, this form is a component of a broader AML compliance program. You must also have written policies, employee training, and independent testing. This form provides the data collection mechanism, but you should consult legal counsel to ensure your entire program meets all requirements.

Self-help document generator: you get a structured draft based on the facts you provide. It is not legal, tax, or financial advice; verify jurisdiction-specific rules before sending.