Credit Rating Services Act, 2012 (Act No. 24 of 2012)

Board Notices

Board Notice 166 of 2013

Annexures

Annexure B

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QUESTIONNAIRE TO BE COMPLETED IN RESPECT OF DIRECTORS AND KEY EMPLOYEES OF AN APPLICANT

1. Personal details of the director or key employee in respect of which this questionnaire is being completed:

1.1 Surname and title:

1.2 Full first name(s):

1.3 Any previous surname(s) or first name(s):

1.4 Indicate the proposed position to be held, e.g. director or managing director:

_________________________________________________________________________________________________________________________________

1.5 Effective date of appointment:

_______________________________________________________________________________________________________________________________

1.6 Residential address and telephone number:

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

1.7 Postal address:

1.8 Personal Details

Date of birth: _____________________________________________________________________

Place of birth: _____________________________________________________________________

Identity Document number (attach a certified copy): ______________________________________________________

Passport number: (attach a certified copy): ______________________________________________________________

Expiry date: ________________________________________________________________

Country of issue: ____________________________________________________________________________

1.9 Nationality

1.10	Professional qualification(s), the year(s) when, and the institution(s) at which, these were acquired (attach a certified copy of the qualification/s):

1.11	If notified and required by the FSB attach completed Personal Credential Verification Forms for purposes of the background screening of each director or key employee. The forms are obtainable on application from the Financial Services Board.

1.12 Attach detailed curriculum vitae.

2. General details in respect of an individual.

2.1	State in what capacity you are completing this document, i.e. as a current or prospective director (executive or non-executive) or key employee. State full job title and describe the particular duties and responsibilities:

2.2	Provide a record of significant investments and shareholding history (including indirect holdings) over at least the last five years (including those holdings which provided you a significant influence over the operations and affairs of the entity invested in or in which you had a shareholding)

3. Specific test to assess fitness and probity

If the answer to a question is 'yes' please provide details. A separate schedule may be completed and attached to this questionnaire with proper referencing.

3.1	Have you, or any business in which you have had a controlling interest or have exercised influence, been investigated, disciplined, suspended or censured by a regulatory or professional body, a court or tribunal, whether publicly or privately?

3.2

Have you ever been associated, in an ownership or management capacity, with a company, partnership or other business association that has been refused registration, authorisation, membership or a license to conduct trade, business or a profession, or has had that registration, authorisation, membership or license revoked, withdrawn or terminated?

3.3	As a result of the removal of the relevant licence, registration or other authority mentioned in question 3.2 above, have you ever been refused the right to carry on a trade, business or profession requiring a licence, registration or other authorisation?

3.4	Have you ever been the subject f any complaint, enquiry, investigation or proceedings which has resulted in disciplinary action being taken against you, your suspension or censure by a regulatory or professional body, a court or tribunal, whether publicly or privately?

3.5

Have you ever been found guilty in any civil or criminal proceedings by a court of law, whether in the Republic of South Africa or elsewhere, of having acted fraudulently, dishonestly, unprofessionally, dishonourably or in breach of a fiduciary duty, forgery, uttering a forged document, perjury or other criminal acts of a financial nature, or are any such proceedings pending?

3.6

Have you ever been found guilty of contravening any of the requirements and standards of a regulatory body, professional body, government or its agencies, or, been found guilty by any professional or financial services industry body, whether in the Republic of South Africa or elsewhere, of an act of dishonesty, negligence, incompetence or mismanagement or are any such proceedings pending?

3.7	Have you been denied membership of any professional or financial services industry body, whether in the Republic of South Africa or elsewhere, on account of an act of dishonesty, negligence, incompetence or mismanagement?

3.8

Have you at any time prior to the date of application been disqualified or prohibited by any court of law, whether in the Republic of South Africa or elsewhere, from taking part in the management of any company or other statutorily created, recognised or regulated body, irrespective of whether such disqualification has since been lifted or not?

3.9	Have you ever been a director, partner, or otherwise involved in the management of a business that has gone into business rescue, curatorship, bankruptcy or liquidation while you have been connected with that business or within one year after that connection?

3.10	Have you ever been dismissed, asked to resign or resigned from employment or from a position of trust, a fiduciary appointment or similar because of questions about and factors relating to your honesty and integrity?

3.11

Have you ever been disqualified, under the Companies Act, 2008, or its predecessor or any other financial services legislation or regulation, whether in the Republic of South Africa or elsewhere, the object of which is the protection of the public against financial loss from acting as a director or serving in a managerial capacity?

3.12	Have you ever been disciplined by a professional, trade or regulatory body, or dismissed or requested to resign from any position or office for dishonesty, negligence, incompetence or mismanagement?

3.13	Have you ever been the subject of any adverse judgment or award, whether in the Republic of South Africa or elsewhere, which remains outstanding or was not satisfied within a reasonable period?

3.14	Have you ever made any arrangements or composition with your creditors, been sequestrated or filed for voluntary sequestration, had your assets repossessed or liquidated or been involved in proceedings relating to these?

3.15	Have you ever been a senior officer or director of a company or a shareholder of a company in a position to exercise influence in the company that:

(a)	has been the subject of any adverse judgment or award, whether in the Republic of South Africa or elsewhere, which remains outstanding or was not satisfied within a reasonable period?

(b)	has, whether in the Republic of South Africa or elsewhere, made any arrangements or composition with its creditors, filed for business rescue, filed for bankruptcy, been adjudged bankrupt, had assets repossessed or liquidated, or been involved in proceedings relating to any of the foregoing?

DECLARATION

(to be completed by individual directors and key employees of an applicant and by the managing director on behalf of an applicant.)

I, the undersigned, (insert full first name(s) and surname) hereby certify that, to the best of my knowledge, the information given in the answers to the above questions are true, complete and accurate and not misleading in any respect.

I undertake that, as long as I continue to be a director or key employee of the registered credit rating agency, I will notify the registrar of any material changes to, or changes affecting the completeness or accuracy of the answers to the questions above as soon as possible, but in no event later than 21 days from the day that the change comes to my attention.

I hereby authorise the Financial Services Board, and its duly authorised verification agent, to request or confirm any personal information as well as any other information that I have provided in support of my application with any personal data holders (including but not limited to the South African Police Service, the Government of the Republic of South Africa, industry bodies and associations, employers and any educational, training, credit bureau and fraud prevention organisations) for the purpose of verifying my personal credentials and records.

Credential verification types include, but are not limited to, educational qualifications, professional membership, employment history, and employment references including industry employment registers, consumer credit, criminal records, driver's licence, and fraud prevention checks.

I authorise the personal data holders (including but not limited to the aforesaid institutions) to furnish information regarding my credentials, whether claimed or not, to the Financial Services Board and it's duly appointed verification agent. I unconditionally indemnify the Financial Services Board, its verification agent and the personal data holders against any liability that may result from furnishing information in this regard.

Full name(s) and surname: ......................................................................................................................

Position held: .........................................................................................................................................

SIGNATURE: DIRECTOR ............................................................................. DATE ......................................................

SIGNATURE: KEY EMPLOYEE ................................................................................. DATE ......................................................

SIGNATURE: COMPANY DIRECTOR, duly authorised as signatory

SIGNATURE: ............................................................................................. DATE .....................................................

Documents to be submitted

•	a certified copy of the identity document or passport;

•	completed Personal Credential Verification Forms;

•	curriculum vitae;

•	signed declaration; and

•	other documents, if any, mentioned in answers to questions and in support of the information required. (Indicate the pages of each enclosure and the number of the question to which the enclosure relates and is referenced).

Credit Rating Services Act, 2012 (Act No. 24 of 2012)

Board Notices

Board Notice 166 of 2013

Annexures

Annexure B

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