Kord
Checkboard Ltd · Client due diligence
Short form

Client due diligence.

Short form for claims management companies and law firms

Checkboard is required to verify the businesses it provides data services to. Complete every field, or enter N/A where a field does not apply. Your answers are saved in this browser as you type and nothing is sent anywhere until you print or download the record. You will separately be asked to complete Equifax's own Client Due Diligence Short Form; this form does not replace it.

Business details

Legal entity

Nature of business

Addresses

Registered address

Trading address

Is either address a home address?

Correspondence address

Billing address

Contact details

Business

Main contact (also signs the declaration)

Regulatory information

Is the business authorised or regulated by the Financial Conduct Authority?

Is the business authorised by the SRA or CLC?

Is the business registered with the Information Commissioner's Office?

Any other licence, registration or regulator required to trade?

Directors and beneficial owners Persons with significant control — 25% or more

List each director, partner or sole proprietor, and anyone owning or controlling 25% or more of the business. At least one person is required.

Use of Checkboard data

Will any data obtained through Checkboard be shared with, or accessed by, a third-party claims management company, law firm, introducer or lead generator?

Has the business previously held, or applied for, an account with Checkboard or Equifax?

Does the business operate or trade from a shared space?

Approved user email domains

Group participants are the Customer's own affiliated companies permitted to use the services for their own benefit under the contract. Connected subcontractors are third-party service providers (which may include affiliates) authorised to connect directly to Checkboard to perform tasks on behalf of the Customer or a Group participant. Only users on these domains will be provisioned.

How Checkboard uses this information

Use of information

Checkboard Ltd is the controller of the information you provide on this form. It is used to open and manage your account, to provide services to you, and to meet Checkboard's legal and regulatory obligations. It may be shared with the credit reference agencies whose data Checkboard supplies, including Equifax, for their own credentialing of your business. Checkboard's privacy notice explains your rights and the legal bases relied on: [checkboard.co.uk/privacy — CONFIRM].

Due diligence checks

Checkboard is required to carry out due diligence on the businesses it serves. On receipt of this form it will:

  • verify the business against Companies House and equivalent registers;
  • verify regulatory status on the FCA, SRA or CLC registers and the ICO register;
  • check business information held by credit reference and fraud prevention agencies — a business search footprint may be recorded;
  • verify the identity of directors, partners and beneficial owners where the risk rating requires it, with separate notice to each individual.

Checks may be repeated periodically while the account is open.

Declaration

  • The information given on this form is complete and accurate, and I am authorised to give it on behalf of the business.
  • The business will notify Checkboard within 14 days of any change to the details above, including regulatory status, ownership, or approved user domains.
  • The business will act as data controller for personal data it obtains through Checkboard's services, and will use that data only for the permitted purpose agreed in its contract.
  • I have read the notices above and have made them available to the individuals named on this form.
Signature (draw with mouse or finger — optional; the confirmation above is your signature if left blank)
No signature drawn

Documents to enclose

For Checkboard use only

Risk rating