Third Party Due Diligence Internal Request Form Third Party Due Diligence Internal Request Form A. Compliance Program Process A1. Program Elements Due Diligence Hospitality, Gifts, Donations, other Training / Certification Help Line Export Controls Data Privacy Communication / Tone at the Top Investigations B. Business Related Information B1. Business Services / Unit Program Evaluation Review Response OtherOther B2. Business Services / Unit North America Latin America EMEA (Europe, Middle East, Africa) Asia / Australia / New Zealand B3. Projects (click here for list) Project002 Project003 Project004 Project005 Project006 Project007 Project008 Project009 Project010 C. Third Party C1. Full Legal Name * C2. Country (s) Services or Items being provided click for country(s) Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Côte d'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Norway Northern Mariana Islands Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Yemen Zambia Zimbabwe C3. Type of Service or Items being provided Marketing / Client Relationship Customs Visa/ Immigration Logistics Permits Licensing Tax Relocation Legal C4. Address * C5. Website * C6. Primary Contact * C7. Third Party - Email Address * C8. Third Party - Primary Contact Phone Number * D. Selection of Third Party D1. The primary reason(s) the Third Party was selected versus another third party * D2. Describe the Third Party`s experience including length of time in business, particular expertise and include names of other companies that work with them * D3. Briefly describe the process that was used in the selection of the Third Party (obtained recommendations, interviewed them, formal tender, etc.) * E. Background of Third Party E1. Is there any concern regarding the reputation of the Third Party from a business integrity or compliance standpoint. For example, has the Third Party faced allegations of bribery, kickbacks, fraud or other wrongdoings? Yes No E2. Did a representative of a [client] or a government official recommend (without us requesting a recommendation) or insist that we use the Third Party? Yes No E3. Has the Third Party requested that they receive payment 1) in a jurisdiction other than the country in which the services are being provided or the country of their corporate headquarters, 2) to an account that does not appear to be their company`s business account or 3) to a party that is not part of the contract? Yes No F. Internal Information F1. Person primarily responsible for the third party relationship F2. Email of Primary Person Responsible [Internal Form F3. Phone number of Primary Person Responsible F4. Email of leader for the Primary Person Responsible F5. Was an additional Business Approval required Yes No If so, was it obtained? NA Yes No Completed and Confirm as Accurate Virtual Signature - Please Check Box Full Name and Title Email Date Submit
