CLIENT ON-BOARDING FORM

FICA SCREENING

As an Accountable Institution under the Financial Intelligence Centre Act (FICA), Nkwali Compliance Consultants is legally required to collect specific information and conduct due diligence on all clients. The information requested below forms part of our regulatory obligations to assess client risk, verify ownership, and perform ongoing monitoring in accordance with FICA requirements.
Ultimate Beneficial Owner (UBO)

A UBO is any individual who ultimately owns, controls, or benefits from a business, either directly or indirectly. Indicate who ultimately controls the money, decisions, or benefits behind the FSP— even if they're not officially listed on CIPC. A UBO includes the shareholders holding direct or indirect shareholding (often 25% or more). Anyone who exercises significant influence or control over the business — even via trust, holding companies, nominees, etc. Directors or individuals who can control funds or operations on behalf of the real owners.
Who is the Ultimate Beneficial Ownership Type of the FSP?*

Natural PersonCompanyTrust

SOLE PROPRIETOR DETAILS
Salutation

Mr.Mrs.Ms.
Sole Proprietor Full Name
Identity / Passport No of Sole Proprietor
Email Address of Sole Proprietor
example@example.com
Phone Number of Sole Proprietor
Please enter a valid phone number.
Select the relevant RE qualification/s of the Sole Proprietor

RE 1RE 5Both RE 1 and RE 5
Attach Qualifications of Sole Proprietor

Cancelof
Attach Certified ID or Passport copy of Sole Proprietor

Cancelof

Attach CIPC Entity Registration Documents (Company or Close Corporation)

Cancelof
Attach Certified ID or Passport copy of Director or member (each director or member if more than 1)*

Cancelof

RISK MANAGEMENT
Do you currently have Professional Indemnity Insurance in place?*

YesNo
Provide the name of your insurer
What is the current PI coverage amount (limit of indemnity)?
PI Cover Renewal Date

MonthDayYear
Date
Financial Year End*
Have all annual financial statements been submitted to the FSCA since the date of authorization?*

YesNo
Please provide a reason/s why the financial statements have not been submitted to FSCA
Do you have an Accountant or Auditor on record?*

YesNo
Accountant or Auditor's Practice or business name
Accountant or Auditor's Name
Accountant or Auditor's Phone Number
Please enter a valid phone number.
Accountant or Auditor's Email
example@example.com

COMPLIANCE
Do you have an existing Compliance Officer that you will be replacing?*

YesNo
Provide reason/s for termination
Select Compliance Officer (CO) you will be working with
Attach the Appointment of Nkwali Compliance Consultants as an external Compliance Officer Form*

Cancelof
Attach the signed Compliance Services Agreement*

Cancelof
Proof of payment of R866 to FSCA (use your FSP number as a reference)*

Cancelof
Proof of Payment to Nkwali Compliance Consultants*

Cancelof
Have you registered as an Accountable Institution on FICs GOAML?*

YesNoNot Sure
GOAML Org ID
Attach the FICA GOAML Compliance Officer Appointment Form

Cancelof
Have you registered your POPI Information Officer in terms of the POPI Act?*

YesNo
Information Officer Name

First NameLast Name

BANKING DETAILS
Banking Institution*
Bank Account Number*
Branch Code*
Bank Account Type*
Debit Date*
Attach Proof of Business Bank Account (Company) or individual bank account (Sole Proprietor)*

Cancelof
PAYMENT POLICY AND PENALTY CHARGES
DECLARATION
Signature*

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Date*

DayMonthYear
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CLIENT ON-BOARDING FORM - FSPs