PART B
RELATED OR OTHER INTEREST
1. Are you a director of any company, partnership, corporate body or any other business organisation engaged in money services business? If so, state—
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(a) name of company/corporated body/etc.;
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(b) nature of business;
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(c) date of commencement of directorship;
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(d) whether or not employed on service contract (e.g. managing directorship) in any case.
2. Have you been a director of a deposit taking institution, credit extending institution, other financial service provider, any other limited company or corporation other than those stated in the previous questions? If so, state—
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(a) name of company/corporation;
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(b) nature of business;
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(c) date of commencement of directorship;
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(d) date of cessation of directorship.
3. Are you or have you been engaged—
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(a) in partnership?; or
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(b) in business as a principal on your own account? If so, give particulars.
4. Are you a beneficial owner of any controlling interest in any unlisted private or public company? If so, give particulars.
5. Have you ever been a director of, or directly concerned with the management of a bank or other financial institution—
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(a) that has been wound up by a court?
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(b) the licence of which has been revoked?
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(c) which has been placed in receivership?
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(d) which has entered into a composition with its creditors?
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(e) whose business had been adjudged to have been conducted imprudently or fraudulently?
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(f) which has failed to meet the solvency requirements prescribed by law?
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If so, give particulars.
6. Have you ever been a director, or been directly concerned with the management or conduct of affairs of any company which has gone into liquidation, whilst you were, or within one year of your being a director, or so concerned? If so, give details of the circumstances including the following—
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(a) name of company;
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(b) name of liquidator;
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(c) address of liquidator.
7. Have you ever been concerned with the management or conduct of affairs of any corporation which, by reason of any matter relating to a time when you were so concerned, has been censured or disciplined by—
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(a) any regulatory authority?
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(b) any official appointed enquiry?
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(c) any other body concerned with regulation of a relevant activity? If so, give particulars.
8. Do you (in your personal capacity or through any entity controlled by you) have outstanding debt of any amount 60 or more days in arrears? If so, state the following—
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(a) form;
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(b) amount;
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(c) source;
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(d) maturity date.
9. Has any person, firm or company guaranteed the indebtedness? If so, give particulars (see previous question).
10. Are you at present guaranteeing the debts and obligations of any third parties? If so, give particulars.
I make this Declaration conscientiously believing the same to be true, accurate, fair, to the best of my knowledge and belief and in accordance with the Statutory Declaration Act, and that I am aware that if there is any statements in this Declaration which is false, or which I know to be false or do not believe to be true, I am liable to imprisonment.
Declared before me
at this day of
| Declarant | Notary Royal |
| ........................................ | ........................................ |
| Signature |