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ALTERNATIVE JURISTIC PERSONS

COMPULSORY FICA QUESTIONNAIRE ALTERNATIVE JURISTIC PERSONS Churches, Schools, Charities, NGOs etc

PLEASE CONFIRM WHETHER ANY OFFICIAL OR MANAGER OF THE ENTITY OR THE ENTITY ITSELF HAS HAD PREVIOUS DEALINGS WITH THE FIRM (BBB ATTORNEYS INC)

PLEASE CONFIRM THE NATURE OF THE CURRENT INTERACTION WITH THE FIRM (BBB ATTORNEYS INC)

REFERENCE NAME OF THE INSTITUTION/ENTITY

NAME AND SURNAME OF THE REPRESENTATIVE

REGISTRATION NUMBER IF APPLICABLE

INCOME TAX & VAT NO. IF APPLICABLE

NATURE OF YOUR BUSINESS

REGISTERED ADDRESS

TRADING ADDRESS

MAIN CONTACT NUMBER

MAIN CONTACT EMAIL

FICA QUESTIONNAIRE

Client identification is an international requirement and we, an accountable institution as defined in the Financial Intelligence Centre Act and Regulations, are obliged to identify our clients. In terms of sections 21, 21A, 21B, 21C and 21E of the FIC Act, we are also obliged to identify and verify: * bank accounts used for purposes of payments to or from you and * the source and origin of the cash monies. These questions below are compulsory

INDUSTRY OF TRADE

COUNTRIES OF TRADE

MAIN COUNTRY OF TRADE

OTHER INDUSTRIES OF TRADE

PUBLIC ENTITY?

Yes

MAIN INDUSTRY OF TRADE

PLEASE CONFIRM WITH WHICH BANK THE ENTITY HOLDS ITS MAIN ACCOUNT?

Are you prepared to share the proof of your banking account if so requested?

Yes

Please note that THE FIRM (BBB ATTORNEYS INC) will advise you of the METHOD by which the banking confirmation letter is to be sent for Data Privacy security purposes

PLEASE CONFIRM WHETHER THE ENTITY HOLDS ANY BANK ACCOUNTS WITH BANKING INSTITUTIONS OUTSIDE OF SOUTH AFRICA?

Are you prepared to share the proof of your banking account if so requested?

Yes

Please note that THE FIRM (BBB ATTORNEYS INC) will advise you of the METHOD by which the banking confirmation letter is to be sent for Data Privacy security purposes

ARE ANY OF THE MANAGERS, MEMBERS, SHAREHOLDERS OR OFFICE BEARERS INVOLVED IN TRADING OF DUAL-USE GOODS SUBJECT TO EXPORT CONTROL OR IS THERE ANY CONNECTION WITH AN UNIVERSITY OR RESEARCH FACILITY INVOLVED IN THE RESEARCH OF DUAL-USE GOODS OR GOODS SUBJECT TO EXPORT CONTROL?

ARE ANY OF THE MANAGERS, MEMBERS, SHAREHOLDERS OR OFFICE BEARERS INVOLVED IN ACTIVITIES DIRECLTY OR INDIRECTLY LINKED WITH THE MANUFACTURING OR SALE OF ARMS OR WEAPONS?

ANY ENTITY OFFICE BEARER A DOMESTIC OR FOREIGN POLITICALLY EXPOSED OR INFLUENTIAL PERSON OR A FAMILY MEMBER OR ASSOCIATE OF SUCH A PERSON *THIS WILL BE VERIFIED

Yes

GENERAL SOURCE OF WEALTH OF THE ENTITY

Supply us with a summary of all the entity’s income earning activities
FOR EXAMPLE: - Business income (please specify) - Rental income - Other investments (please specify)

PLEASE CONFIRM THE ENTITY’S GENERAL SOURCE OF FUNDS IN RESPECT OF THE TRANSACTION For example:

If you are a property party, from which funds are you paying for the property or costs related to the property
If you are a commercial or litigation client, from which funds are you paying the fees or other amounts in the transaction?

LIST ALL EXECUTIVE MANAGERS FULL NAMES AND ID’S

LIST ALL THE OFFICE BEARERS OF THE ENTITY FULL NAMES AND ID’S

PLEASE CONFIRM THE OCCUPATION OF ALL OFFICE BEARERS

PLEASE CONFIRM THE INDUSTRY OF TRADE FOR EACH OFFICE BEARER

ALTERNATIVE JURISTIC PERSONS VERIFICATION DOCUMENTS
Please take note that we require documentary proof for verification purposes of the following items (please tick item off if provided):

Resolution of Authorised Signatories

Constitution; OR Founding documents; OR Other documents relating the founding of the legal juristic client

Certified extract from minutes proving authority, Letter of appointment, Power of manager, Mandate, Written instruction, Court order

Letterhead confirming operating address as well as trading name

Proof of Identification and authority for all Managers, Office Bearers and Authorised Signatories

Proof of Address for all Managers & Authorised Signatories

CheckboxWe may also require documentary proof for verification purposes at any stage of the transaction or business relationship which may include the following items (please tick item off if provided): Field

Tax Clearance/Official document from SARS confirming Income Tax Number

Completion of the FICA questionnaire for the natural person by all Managers, Office Bearers and Authorised Signatories

Proof of banking details

Proof of Source of Income (only if required)

DECLARATION: I confirm that all the information completed on both the ENTITY’S FICA questionnaire together with the information completed on this ENTITY Representative FICA questionnaire IS CORRECT and that I have truthfully completed all such questions. I confirm further that the ENTITY on whose behalf I am acting as Representative does not trade in illegal activities.

Agree

ALTERNATIVE JURISTIC PERSONS INDIVIDUAL REPRESENTATIVE/S TO COMPLETE

HAVE YOU PREVIOUSLY DEALT WITH THE FIRM (BBB ATTORNEYS INC) AND IF SO, PLEASE SUPPLY A SUMMARY

PARTY 1	PARTY 2

WHAT IS THE NATURE OF YOUR CURRENT INTERACTION WITH THE FIRM (BBB ATTORNEYS INC)

PARTY 1	PARTY 2

FULL NAMES

PARTY 1	PARTY 2

ID/PASSPORT NUMBERS

PARTY 1	PARTY 2

RSA RESIDENT

PARTY 1	PARTY 2

IF NON-RESIDENT, PLEASE CONFIRM THE PLACE OF PERMANENT RESIDENCY

PARTY 1	PARTY 2

IF FOREIGN, PLACE OF BIRTH

PARTY 1	PARTY 2

RSA VISA ISSUED IF FOREIGN

PARTY 1	PARTY 2

INCOME TAX NUMBER

PARTY 1	PARTY 2

PLEASE CONFIRM TAX BASE IF NOT SOUTH AFRICA

PARTY 1	PARTY 2

MARITAL STATUS

PARTY 1	PARTY 2

EMPLOYER

PARTY 1	PARTY 2

EMPLOYER CONTACT DETAILS

PARTY 1	PARTY 2

EMPLOYER ADDRESS

PARTY 1	PARTY 2

YOUR CONTACT NUMBER

PARTY 1	PARTY 2

YOUR CONTACT EMAIL

PARTY 1	PARTY 2

FICA QUESTIONS

Client identification is an international requirement and we, an accountable institution as defined in the Financial Intelligence Centre Act and Regulations, are obliged to identify our clients. in terms of sections 21, 21A, 21B, 21C and 21E of the FIC Act, we are also obliged to identify and verify: * bank accounts used for purposes of payments to or from you and * the source and origin of the cash monies.

These questions below are compulsory

MAIN OCCUPATION

PARTY 1	PARTY 2

INDUSTRY OF TRADE

PARTY 1	PARTY 2

OTHER INDUSTRIES OF TRADE

PARTY 1	PARTY 2

COUNTRIES OF TRADE

PARTY 1	PARTY 2

DO YOU HOLD INTEREST IN ANY ENTITY (COMPANY OR TRUST) REGISTERED ABROAD

PARTY 1	PARTY 2

ARE YOU INVOLVED IN TRADING OF DUAL-USE GOODS SUBJECT TO EXPORT CONTROL OR IS THERE ANY CONNECTION WITH AN UNIVERSITY OR RESEARCH FACILITY INVOLVED IN THE RESEARCH OF DUAL-USE GOODS OR GOODS SUBJECT TO EXPORT CONTROL?

Examples of dual-use goods and technology include global positioning satellites, missiles, nuclear technology, chemical and biological tools, night vision technology, thermal imaging, some models of drones, aluminium pipes with precise specifications or certain kinds of ball bearings.

PARTY 1	PARTY 2

ARE YOU INVOLVED ACTIVITIES DIRECLTY OR INDIRECTLY LINKED WITH THE MANUFACTURING OR SALE OF ARMS OR WEAPONS?

PARTY 1	PARTY 2

ARE YOU A DOMESTIC OR FOREIGN POLITICALLY EXPOSED OR INFLUENTIAL PERSON OR A FAMILY MEMBER OR ASSOCIATE OF SUCH A PERSON *THIS WILL BE VERIFIED

PARTY 1	PARTY 2

INDIVIDUAL VERIFICATION DOCUMENTS

Copy of Green bar-coded South African ID/card or Passport if foreign and/or Residency VISA if applicable

Marriage Certificate and Antenuptial Agreement if applicable

Proof of Address (in the form of a utility bill, telephone account, lease agreement or alternatives issued by a 3rd party)

In addition to the above, please take note that we may require documentary proof for verification purposes at any stage of the transaction or business relationship of the following:

Tax Clearance/Official document from SARS confirming your Income Tax Number (if requested)

Proof of banking details

Proof of Source of Income

Information regarding your Source of Wealth (only if required)

Agree

FOREIGN COMPANIES

HAS THE FOREIGN COMPANY OR ANY OF ITS DIRECTORS, SHAREHOLDERS OR MEMBERS PREVIOUSLY DEALT WITH THE FIRM (BBB ATTORNEYS INC) AND IF SO, PLEASE SUPPLY A SUMMARY

WHAT IS THE NATURE OF THE FOREIGN COMPANY’S INTERACTION WITH THE FIRM (BBB ATTORNEYS INC)

REGISTERED NAME

TRADING NAME

REGISTRATION NUMBER

INCOME TAX NUMBER

WHICH REVENUE OFFICE ISSUED THE TAX NUMBER

NATURE OF YOUR BUSINESS

REGISTERED ADDRESS

TRADING ADDRESS

MAIN CONTACT NUMBER

MAIN CONTACT EMAIL

FICA QUESTIONNAIRE

These questions below are compulsory

COUNTRIES OF TRADE

MAIN COUNTRY OF TRADE

PUBLIC COMPANY

Yes

STATE OWNED COMPANY

Yes

OTHER INDUSTRIES OF TRADE

PLEASE CONFIRM WITH WHICH BANK THE COMPANY HOLDS ITS MAIN ACCOUNT?

Are you prepared to share the proof of your banking account if so requested?

Yes

Please note that THE FIRM (BBB ATTORNEYS INC) will advise you of the METHOD by which the banking confirmation letter is to be sent for Data Privacy security purposes

PLEASE CONFIRM WHETHER THE COMPANY HOLDS ANY BANK ACCOUNTS WITH BANKING INSTITUTIONS IN ANY OTHER COUNTRY?

Are you prepared to share the proof of your banking account if so requested?

Yes

Please note that THE FIRM (BBB ATTORNEYS INC) will advise you of the METHOD by which the banking confirmation letter is to be sent for Data Privacy security purposes

ARE ANY OF THE DIRECTORS OR SHAREHOLDERS INVOLVED IN TRADING OF DUAL-USE GOODS SUBJECT TO EXPORT CONTROL OR IS THERE ANY CONNECTION WITH AN UNIVERSITY OR RESEARCH FACILITY INVOLVED IN THE RESEARCH OF DUAL-USE GOODS OR GOODS SUBJECT TO EXPORT CONTROL?

ARE ANY OF THE DIRECTORS, SHAREHOLDERS OR OFFICE BEARERS INVOLVED IN ACTIVITIES DIRECLTY OR INDIRECTLY LINKED WITH THE MANUFACTURING OR SALE OF ARMS OR WEAPONS?

ANY DIRECTOR OR SHAREHOLDER A DOMESTIC OR FOREIGN POLITICALLY EXPOSED OR INFLUENTIAL PERSON OR A FAMILY MEMBER OR ASSOCIATE OF SUCH A PERSON *THIS WILL BE VERIFIED

Yes

GENERAL SOURCE OF WEALTH OF THE COMPANY

Supply us with a summary of all your company income earning activities
FOR EXAMPLE:
- Business income (please specify)
- Rental income
- Other investments (please specify)

PLEASE CONFIRM THE COMPANY’S GENERAL SOURCE OF FUNDS IN RESPECT OF THE TRANSACTION

For example:

If you are a property party, from which funds are you paying for the property, or costs related to the property
If you are a commercial or litigation client, from which funds are you paying the fees or other amounts in the transaction?

LIST ALL DIRECTORS / FULL NAMES AND ID’S

Full Name	ID Number

SHAREHOLDING

Please confirm the details of all the shareholders Please confirm the details of all the UBOs in the event of a multi layered shareholding Please provide proof thereof

Please confirm the details of the ultimate persons/juristic persons who individually or collectively control the company (i.e. have a material influence on the company operations) Please provide proof thereof

Company executive managers

PLEASE CONFIRM THE OCCUPATION OF EACH DIRECTOR AND SHAREHOLDER

PLEASE CONFIRM THE INDUSTRY/INDUSTRIES OF TRADE FOR EACH DIRECTOR AND EACH SHAREHOLDER

IF SHARES ARE ISSUED TO OTHER JURISTIC PERSONS, PLEASE LIST THE OTHER JURISTIC PERSONS’ SHAREHOLDING and SUPPLY AN ORGANOGRAM FOR THE OWNERSHIP STRUCTURE

COMPANY VERIFICATION DOCUMENTS

Please take note that we require documentary proof for verification purposes of the following items (please tick item off if provided):

Resolution of Authorised Signatories

Company shareholding structure (of which certain natural/legal persons will be subject to further due diligence)

Documentary evidence of the juristic client's existence that is consistent with practices in the local market and reflects the registered name and registration number (e.g. a print-out of the web-page of a govt-sponsored corporate registry, Certificate of Incorporation/Registration, Audited Report / Financial Statements)

Any other proof of registration of changes in company information since incorporation

Independent documentary evidence reflecting the Operating Name / Trading Name (e.g. letterhead, proof of address, business invoice)

Recent documentary evidence of the operating address

We may also require documentary proof for verification purposes at any stage of the transaction or business relationship which may include the following items (please tick item off if provided):

Tax Clearance/Official document from the local Revenue office confirming Income Tax and/or VAT Numbers

Completion of the FICA questionnaire for natural persons by all Directors, Shareholders, Managers & Authorised Signatories

Proof of banking details

Proof of Source of Income (only if required)

DECLARATION: I confirm that all the information completed on both the Company/Close Corporation FICA questionnaire together with the information completed on this Company/Close Corporation Representative FICA questionnaire IS CORRECT and that I have truthfully completed all such questions. I confirm further that the Company/Close Corporation on whose behalf I am acting as Representative does not trade in illegal activities.

Agree

FOREIGN COMPANY INDIVIDUAL REPRESENTATIVE/S TO COMPLETE

HAVE YOU PREVIOUSLY DEALT WITH THE FIRM (BBB ATTORNEYS INC) AND IF SO, PLEASE SUPPLY A SUMMARY

PARTY 1	PARTY 2

WHAT IS THE NATURE OF YOUR CURRENT INTERACTION WITH THE FIRM (BBB ATTORNEYS INC)

PARTY 1	PARTY 2

FULL NAMES

PARTY 1	PARTY 2

ID/PASSPORT NUMBERS

PARTY 1	PARTY 2

RSA RESIDENT Party 1

Yes

RSA RESIDENT Party 2

Yes

IF NON-RESIDENT, PLEASE CONFIRM THE PLACE OF PERMANENT RESIDENCY

PARTY 1	PARTY 2

IF FOREIGN, PLACE OF BIRTH

PARTY 1	PARTY 2

RSA VISA ISSUED IF FOREIGN Party 1

Yes

RSA VISA ISSUED IF FOREIGN Party 2

Yes

INCOME TAX NUMBER

PARTY 1	PARTY 2

PLEASE CONFIRM TAX BASE IF NOT SOUTH AFRICA

PARTY 1	PARTY 2

MARITAL STATUS

PARTY 1	PARTY 2

ADDRESS (DOMICILIUM)

PARTY 1	PARTY 2

EMPLOYER

PARTY 1	PARTY 2

EMPLOYER CONTACT DETAILS

PARTY 1	PARTY 2

EMPLOYER ADDRESS

PARTY 1	PARTY 2

YOUR CONTACT NUMBER

PARTY 1	PARTY 2

YOUR CONTACT EMAIL

PARTY 1	PARTY 2

FICA QUESTIONS

Client identification is an international requirement and we, an accountable institution as defined in the financial intelligence centre act and regulations, are obliged to identify our clients. in terms of sections 21, 21A, 21B, 21C and 21E of the FIC Act, we are also obliged to identify and verify: * bank accounts used for purposes of payments to or from you and * the source and origin of the cash monies.

These questions below are compulsory

MAIN OCCUPATION

PARTY 1	PARTY 2

INDUSTRY OF TRADE

PARTY 1	PARTY 2

OTHER INDUSTRIES OF TRADE

PARTY 1	PARTY 2

COUNTRIES OF TRADE

PARTY 1	PARTY 2

DO YOU HOLD INTEREST IN ANY ENTITY (COMPANY OR TRUST) REGISTERED IN SOUTH AFRICA OR ABROAD

PARTY 1	PARTY 2

PARTY 1	PARTY 2

ARE YOU INVOLVED IN ACTIVITIES DIRECLTY OR INDIRECTLY LINKED WITH THE MANUFACTURING OR SALE OF ARMS OR WEAPONS?

PARTY 1	PARTY 2

ARE YOU A DOMESTIC OR FOREIGN POLITICALLY EXPOSED OR INFLUENTIAL PERSON OR A FAMILY MEMBER OR ASSOCIATE OF SUCH A PERSON *THIS WILL BE VERIFIED - Party 1

Yes

ARE YOU A DOMESTIC OR FOREIGN POLITICALLY EXPOSED OR INFLUENTIAL PERSON OR A FAMILY MEMBER OR ASSOCIATE OF SUCH A PERSON *THIS WILL BE VERIFIED - Party 2

Yes

INDIVIDUAL VERIFICATION DOCUMENTS

Copy of Green bar-coded South African ID/card or Passport if foreign and/or Residency VISA if applicable

Marriage Certificate and Antenuptial Agreement if applicable

Proof of Address (in the form of a utility bill, telephone account, lease agreement or alternatives issued by a 3rd party)

In addition to the above, please take note that we may require documentary proof for verification purposes at any stage of the transaction or business relationship of the following:

Tax Clearance/Official document from the Revenue office confirming your Income Tax Number (if requested)

Proof of banking details

Proof of Source of Income

Information regarding your Source of Wealth (only if required)

Yes

SHAREHOLDERS’ DECLARATION:

SHAREHOLDER 1

% of ownership

Name & surname

Mobile no.

Home no.

Owner industry experience

ID number

Email Address

Physical address

Ethnicity

Town/City

Gender

Postal address

Town/City

SHAREHOLDER 2

% of ownership

Name & surname

Mobile no.

Home no.

Owner industry experience

ID number

Email Address

Physical address

Ethnicity

Town/City

Gender

Postal address

Town/City

SHAREHOLDER 3

% of ownership

Name & surname

Mobile no.

Home no.

Owner industry experience

ID number

Email Address

Physical address

Ethnicity

Town/City

Gender

Postal address

Town/City

TRUSTS

Please note that the information herein collected is required in terms of the Financial Intelligence Centre Act 2001 as amended and will be used for purposes stipulated within the FIC Act. In terms of the provisions contained in the POPIA 2013, and in line with the Privacy Policy of THE FIRM (BBB ATTORNEYS INC), information herein completed will not be shared with third parties unless so indicated or unless it is necessary to give effect to your transaction and then only with other professionals involved in the transaction. Please note that some of the information you have supplied may need to be shared with outside authorities for formal verification purposes (such as the Deeds Office, FIC, SARS, the Court or similar) and your signature of this form constitutes your permission for THE FIRM (BBB ATTORNEYS INC) to share the information accordingly.

COMPULSORY FICA QUESTIONNAIRE TRUSTS

HAS THE TRUST, ANY TRUSTEE OR ANY BENEFICIARY HAD PREVIOUS DEALINGS WITH THE FIRM (BBB ATTORNEYS INC)

PLEASE CONFIRM THE NATURE OF THE TRUST’S INTERACTION WITH THE FIRM (BBB ATTORNEYS INC)

TRUST NAME

TRUST NUMBER

INCOME TAX & VAT NO.

ADDRESS

CONTACT NUMBER

CONTACT EMAIL

WHICH MASTER’S OFFICE ADMINISTERS THE TRUST

PLEASE CONFIRM WHERE THE TRUST IS REGISTERED, IF NOT SOUTH AFRICA?

NAMES AND ID NUMBER OF THE DONOR AND MAIN PLACE OF RESIDENCE OF THE DONOR

FICA QUESTIONNAIRE

These questions below are compulsory

INDUSTRY OF TRADE

COUNTRIES OF TRADE

MAIN COUNTRY OF TRADE

MAIN INDUSTRY OF TRADE

OTHER INDUSTRIES OF TRADE

PLEASE CONFIRM WITH WHICH BANK THE TRUST HOLDS ITS MAIN ACCOUNT?

Yes

Please note that THE FIRM (BBB ATTORNEYS INC) will advise you of the METHOD by which the banking confirmation letter is to be sent for Data Privacy security purposes

PLEASE CONFIRM WHETHER THE TRUST HOLDS ANY BANK ACCOUNTS WITH BANKING INSTITUTIONS OUTSIDE OF SOUTH AFRICA?

Yes

Please note that THE FIRM (BBB ATTORNEYS INC) will advise you of the METHOD by which the banking confirmation letter is to be sent for Data Privacy security purposes

ARE ANY OF THE TRUSTEES OR BENEFICIARIES IN THE TRUST INVOLVED IN TRADING OF DUAL-USE GOODS SUBJECT TO EXPORT CONTROL OR IS THERE ANY CONNECTION WITH AN UNIVERSITY OR RESEARCH FACILITY INVOLVED IN THE RESEARCH OF DUAL-USE GOODS OR GOODS SUBJECT TO EXPORT CONTROL?

ARE ANY OF THE TRUSTEES OR BENEFICIARIES INVOLVED IN ACTIVITIES DIRECLTY OR INDIRECTLY LINKED WITH THE MANUFACTURING OR SALE OF ARMS OR WEAPONS?

ARE ANY TRUSTEE AND/OR BENEFICIARY A DOMESTIC OR FOREIGN POLITICALLY EXPOSED OR INFLUENTIAL PERSON OR A FAMILY MEMBER OR ASSOCIATE OF SUCH A PERSON *THIS WILL BE VERIFIED

Yes

GENERAL SOURCE OF WEALTH OF THE TRUST

Supply us with a summary of all the Trust’s income earning activities
FOR EXAMPLE:
- Business income (please specify)
- Rental income
- Other investments (please specify)

GENERAL SOURCE OF WEALTH OF THE TRUST

PLEASE CONFIRM THE TRUST’S GENERAL SOURCE OF FUNDS IN RESPECT OF THE TRANSACTION

For example:

If you are a property party, from which funds are you paying for the property or costs related to the property
If you are a commercial or litigation client, from which funds are you paying the fees or other amounts in the transaction?

PLEASE CONFIRM THE TRUST’S GENERAL SOURCE OF FUNDS IN RESPECT OF THE TRANSACTION

ALL PRESENT TRUSTEES FULL NAMES AND ID’S

Full Names	ID Number

ALL NAMED BENEFICIARIES’ NAMES AND IDs

Full Names	ID Number

AUTHORIZED REPRESENTATIVE TRUSTEE NAME AND ID

Full Names	ID Number

PLEASE CONFIRM THE OCCUPATION FOR EACH TRUSTEE AND EACH BENEFICIARY

PLEASE CONFIRM THE INDUSTRY/INDUSTRIES OF TRADE FOR EACH TRUSTEE AND BENEFICIARY

TRUST VERIFICATION DOCUMENTS Please take note that we require documentary proof for verification purposes of the following items (please tick item off if provided):

Trust Deed (reflecting name, number & Beneficiaries of Trust)

Resolution of Authorised Trustee/Letters of Authority (authority provided by Master’s Office)

ID & Proof of Address for all Trustees/Beneficiaries/Authorised Signatories/Founder/Donor/Persons acting on behalf of the Trust

TRUSTS CREATED OUTSIDE OF SOUTH AFRICA:

Founding documentation; AND

Letter of authority issued by the authority administering laws relating to Trusts in that country

We may also require documentary proof for verification purposes at any stage of the transaction or business relationship which may include the following items (please tick item off if provided):

Tax Clearance/Official document from the SARS/ Revenue office confirming Income Tax Number

Completion of the FICA questionnaire for natural persons by all Trustees/Beneficiaries/Authorised Signatories/Founder/Donor/Persons acting on behalf of the Trust

Proof of banking details

Proof of Source of Income (only if required)

DECLARATION: I confirm that all the information completed on both the Trust FICA questionnaire together with the information completed on this Trust Representative FICA questionnaire IS CORRECT and that I have truthfully completed all such questions. I confirm further that the Trust on whose behalf I am acting as Representative does not trade in illegal activities.

Yes

TRUST INDIVIDUAL REPRESENTATIVE/S TO COMPLETE

HAVE YOU PREVIOUSLY DEALT WITH THE FIRM (BBB ATTORNEYS INC) AND IF SO, PLEASE SUPPLY A SUMMARY

Party 1	Party 2

WHAT IS THE NATURE OF YOUR CURRENT INTERACTION WITH THE FIRM (BBB ATTORNEYS INC)

Party 1	Party 2

FULL NAMES

Party 1	Party 2

ID/PASSPORT NUMBERS

Party 1	Party 2

RSA RESIDENT - Party 1

Yes

RSA RESIDENT - Party 2

Yes

IF NON-RESIDENT, PLEASE CONFIRM THE PLACE OF PERMANENT RESIDENCY

Party 1	Party 2

IF FOREIGN, PLACE OF BIRTH

Party 1	Party 2

RSA VISA ISSUED IF FOREIGN - Party 1

Yes

RSA VISA ISSUED IF FOREIGN - Party 2

Yes

INCOME TAX NUMBER

Party 1	Party 2

PLEASE CONFIRM TAX BASE IF NOT SOUTH AFRICA

Party 1	Party 2

MARITAL STATUS

Party 1	Party 2

ADDRESS (DOMICILIUM)

EMPLOYER

Part 1	Party 2

EMPLOYER CONTACT DETAILS

Part 1	Party 2

EMPLOYER ADDRESS

Part 1	Party 2

YOUR CONTACT NUMBER

Part 1	Party 2

YOUR CONTACT EMAIL

Part 1	Party 2

FICA QUESTIONS

Client identification is an international requirement and we, an accountable institution as defined in the Financial Intelligence Centre Act and Regulations, are obliged to identify our clients. in terms of sections 21, 21A, 21B, 21C and 21E of the FIC Act, we are also obliged to identify and verify: * bank accounts used for purposes of payments to or from you and * the source and origin of the cash monies.

These questions below are compulsory

MAIN OCCUPATION

INDUSTRY OF TRADE

OTHER INDUSTRIES OF TRADE

COUNTRIES OF TRADE

DO YOU HOLD INTEREST IN ANY OTHER ENTITY (COMPANY OR TRUST) REGISTERED ABROAD

Part 1	Party 2

Part 1	Party 2

ARE YOU INVOLVED IN ACTIVITIES DIRECLTY OR INDIRECTLY LINKED WITH THE MANUFACTURING OR SALE OF ARMS OR WEAPONS?

Part 1	Party 2

ARE YOU A DOMESTIC OR FOREIGN POLITICALLY EXPOSED OR INFLUENTIAL PERSON OR A FAMILY MEMBER OR ASSOCIATE OF SUCH A PERSON *THIS WILL BE VERIFIED - Party 1

Yes

ARE YOU A DOMESTIC OR FOREIGN POLITICALLY EXPOSED OR INFLUENTIAL PERSON OR A FAMILY MEMBER OR ASSOCIATE OF SUCH A PERSON *THIS WILL BE VERIFIED - Party 2

Yes

INDIVIDUAL VERIFICATION DOCUMENTS

Copy of Green bar-coded South African ID/card or Passport if foreign and/or Residency VISA if applicable

Marriage Certificate and Antenuptial Agreement if applicable

Proof of Address (in the form of a utility bill, telephone account, lease agreement or alternatives issued by a 3rd party)

In addition to the above, please take note that we may require documentary proof for verification purposes at any stage of the transaction or business relationship of the following:

Tax Clearance/Official document from SARS confirming your Income Tax Number (if requested)

Proof of banking details

Proof of Source of Income

Information regarding your Source of Wealth (only if required)

Yes

COMPULSORY FICA QUESTIONNAIRE COMPANIES / CLOSE CORPORATIONS

HAS THE COMPANY OR CLOSE CORPORATION OR ANY OF ITS DIRECTORS, SHAREHOLDERS OR MEMBERS PREVIOUSLY DEALT WITH THE FIRM (BBB ATTORNEYS INC) AND IF SO, PLEASE SUPPLY A SUMMARY

WHAT IS THE NATURE OF THE COMPANY OR CLOSE CORPORATION’S INTERACTION WITH THE FIRM (BBB ATTORNEYS INC)

REGISTERED NAME

TRADING NAME

REGISTRATION NUMBER

INCOME TAX & VAT NO

NATURE OF YOUR BUSINESS

REGISTERED ADDRESS

TRADING ADDRESS

MAIN CONTACT NUMBER

MAIN CONTACT EMAIL

IS THE COMPANY AN ACCOUNTABLE INSTITUTION?

Yes

FICA QUESTIONNAIRE

These questions below are compulsory

COUNTRIES OF TRADE

MAIN COUNTRY OF TRADE

PUBLIC COMPANY

Yes

STATE OWNED COMPANY

Yes

MAIN INDUSTRY OF TRADE

OTHER INDUSTRIES OF TRADE

PLEASE CONFIRM WITH WHICH BANK THE COMPANY or CLOSE CORPORATION HOLDS ITS MAIN ACCOUNT?

Yes

Please note that THE FIRM (BBB ATTORNEYS INC) will advise you of the METHOD by which the banking confirmation letter is to be sent for Data Privacy security purposes

PLEASE CONFIRM WHETHER THE COMPANY or CLOSE CORPORATION HOLDS ANY BANK ACCOUNTS WITH BANKING INSTITUTIONS OUTSIDE OF SOUTH AFRICA?

Yes

Please note that THE FIRM (BBB ATTORNEYS INC) will advise you of the METHOD by which the banking confirmation letter is to be sent for Data Privacy security purposes

ARE ANY OF THE DIRECTORS, MEMBERS OR SHAREHOLDERS INVOLVED IN TRADING OF DUAL-USE GOODS SUBJECT TO EXPORT CONTROL OR IS THERE ANY CONNECTION WITH AN UNIVERSITY OR RESEARCH FACILITY INVOLVED IN THE RESEARCH OF DUAL-USE GOODS OR GOODS SUBJECT TO EXPORT CONTROL?

ARE ANY OF THE DIRECTORS, MEMBERS, SHAREHOLDERS OR OFFICE BEARERS INVOLVED IN ACTIVITIES DIRECLTY OR INDIRECTLY LINKED WITH THE MANUFACTURING OR SALE OF ARMS OR WEAPONS?

ANY DIRECTOR, SHAREHOLDER OR MEMBER A DOMESTIC OR FOREIGN POLITICALLY EXPOSED OR INFLUENTIAL PERSON OR A FAMILY MEMBER OR ASSOCIATE OF SUCH A PERSON *THIS WILL BE VERIFIED

Yes

LIST ALL DIRECTORS / FULL NAMES AND ID’S

FULL NAMES	ID Number

SHAREHOLDING

Please confirm the details of all the shareholders Please confirm the details of all the UBOs in the event of a multi layered shareholding

Please confirm the details of the ultimate persons/juristic persons who individually or collectively control the company / close corporation (i.e. have a material influence on the company or close corporation’s operations)

Company / close corporation’s executive managers

PLEASE CONFIRM THE OCCUPATION OF EACH DIRECTOR, SHAREHOLDER OR MEMBER

PLEASE CONFIRM THE INDUSTRY/INDUSTRIES OF TRADE FOR EACH DIRECTOR, EACH SHAREHOLDER OR EACH MEMBER

IF SHARES ARE ISSUED TO OTHER JURISTIC PERSONS, PLEASE LIST THE OTHER JURISTIC PERSONS’ SHAREHOLDING and SUPPLY AN ORGANOGRAM FOR THE OWNERSHIP STRUCTURE

COMPANY VERIFICATION DOCUMENTS

Please take note that we require documentary proof for verification purposes of the following items (please tick item off if provided):

Resolution of Authorised Signatories

Company shareholding structure (of which certain natural/legal persons will be subject to further due diligence)

FOR COMPANIES REGISTERED PRIOR TO 1 MAY 2011: Certificate of incorporation (CM1), Certificate to commence business (CM46), Certificate to commence name change (CM9) – Only if applicable, Memorandum (CM2/CM4 - about 4 pages) AND Articles of Association (CM44 - about 6-9 pages)

FOR COMPANIES REGISTERED AFTER 1 MAY 2011: Registration certificate (Cor 14.3); OR Notice of Incorporation (Cor 14.1); OR If name has changed (Cor 15.2); OR Notice of conversion (Cor 18.3) if CC was converted; OR independently obtained CIPC.

Letterhead confirming operating address as well as trading name

Proof of Identification for all Directors, Shareholders & Authorised Signatories

Proof of Address for all Directors, Shareholders & Authorised Signatories

We may also require documentary proof for verification purposes at any stage of the transaction or business relationship which may include the following items (please tick item off if provided):

Tax Clearance/Official document from SARS confirming Income Tax and/or VAT Numbers

Completion of the FICA questionnaire for natural persons by all Directors, Managers & Authorised Signatories

Proof of banking details

Proof of Source of Income (only if required)

CLOSE CORPORATION VERIFICATION DOCUMENTS

Please take note that we require documentary proof for verification purposes of the following items (please tick item off if provided):

Resolution of Authorised Signatories

Copy of Incorporation Documents (CIPC) reflecting registered name & address

Letterhead confirming operating address as well as trading name

Proof of Identification for all Members & Authorised Signatories

Proof of Address for all Members & Authorised Signatories

We may also require documentary proof for verification purposes at any stage of the transaction or business relationship which may include the following items (please tick item off if provided):

Tax Clearance/Official document from SARS confirming your Income Tax Number

Completion of the FICA questionnaire for natural persons by all Members & Authorised Signatories

Proof of banking details

Proof of Source of Income (only if required)

Agree

HAVE YOU PREVIOUSLY DEALT WITH THE FIRM (BBB ATTORNEYS INC) AND IF SO, PLEASE SUPPLY A SUMMARY

PARTY 1	PARTY 2

WHAT IS THE NATURE OF YOUR CURRENT INTERACTION WITH THE FIRM (BBB ATTORNEYS INC)

PARTY 1	PARTY 2

FULL NAMES

PARTY 1	PARTY 2

ID/PASSPORT NUMBERS

PARTY 1	PARTY 2

RSA RESIDENT PARTY 1

Yes

RSA RESIDENT PARTY 2

Yes

IF NON-RESIDENT, PLEASE CONFIRM THE PLACE OF PERMANENT RESIDENCY

PARTY 1	PARTY 2

IF FOREIGN, PLACE OF BIRTH

PARTY 1	PARTY 2

RSA VISA ISSUED IF FOREIGN PARTY 1

Yes

RSA VISA ISSUED IF FOREIGN PARTY 2

Yes

INCOME TAX NUMBER

PARTY 1	PARTY 2

PLEASE CONFIRM TAX BASE IF NOT SOUTH AFRICA

PARTY 1	PARTY 2

MARITAL STATUS

PARTY 1	PARTY 2

ADDRESS (DOMICILIUM)

PARTY 1	PARTY 2

EMPLOYER

PARTY 1	PARTY 2

EMPLOYER CONTACT DETAILS

PARTY 1	PARTY 2

EMPLOYER ADDRESS

PARTY 1	PARTY 2

YOUR CONTACT NUMBER

PARTY 1	PARTY 2

YOUR CONTACT EMAIL

PARTY 1	PARTY 2

FICA QUESTIONS

These questions below are compulsory

MAIN OCCUPATION

PARTY 1	PARTY 2

INDUSTRY OF TRADE

PARTY 1	PARTY 2

OTHER INDUSTRIES OF TRADE

PARTY 1	PARTY 2

COUNTRIES OF TRADE

PARTY 1	PARTY 2

DO YOU HOLD INTEREST IN ANY ENTITY (COMPANY OR TRUST) REGISTERED IN SOUTH AFRICA OR ABROAD

PARTY 1	PARTY 2

PARTY 1	PARTY 2

ARE YOU INVOLVED IN ACTIVITIES DIRECLTY OR INDIRECTLY LINKED WITH THE MANUFACTURING OR SALE OF ARMS OR WEAPONS?

PARTY 1	PARTY 2

ARE YOU A DOMESTIC OR FOREIGN POLITICALLY EXPOSED OR INFLUENTIAL PERSON OR A FAMILY MEMBER OR ASSOCIATE OF SUCH A PERSON *THIS WILL BE VERIFIED PARTY 1

Yes

ARE YOU A DOMESTIC OR FOREIGN POLITICALLY EXPOSED OR INFLUENTIAL PERSON OR A FAMILY MEMBER OR ASSOCIATE OF SUCH A PERSON *THIS WILL BE VERIFIED PARTY 2

Yes

INDIVIDUAL VERIFICATION DOCUMENTS

Copy of Green bar-coded South African ID/card or Passport if foreign and/or Residency VISA if applicable

Marriage Certificate and Antenuptial Agreement if applicable

Proof of Address (in the form of a utility bill, telephone account, lease agreement or alternatives issued by a 3rd party)

In addition to the above, please take note that we may require documentary proof for verification purposes at any stage of the transaction or business relationship of the following:

Tax Clearance/Official document from SARS confirming your Income Tax Number (if requested)

Proof of banking details

Proof of Source of Income

Information regarding your Source of Wealth (only if required)

Yes

SHAREHOLDERS’ DECLARATION

SHAREHOLDER 1

% of ownership

Name & surname

Mobile no.

Owner industry experience

Home no.

ID number

Email Address

Physical address

Ethnicity

Town/City

Gender

Postal address

Town/City

SHAREHOLDER 2

% of ownership

Name & surname

Mobile no.

Owner industry experience

Home no.

ID number

Email Address

Physical address

Ethnicity

Town/City

Gender

Postal address

Town/City

SHAREHOLDER 3

% of ownership

Name & surname

Mobile no.

Owner industry experience

Home no.

ID number

Email Address

Physical address

Ethnicity

Town/City

Gender

Postal address

Town/City

INDIVIDUALS

Please note that the information herein collected is required in terms of the Financial Intelligence Centre Act 2001 as amended and will be used for purposes stipulated within the FIC Act. In terms of the provisions contained in the POPIA 2013, and in line with the Privacy Policy of THE FIRM (BBB ATTORNEYS INC) information herein completed will not be shared with third parties unless so indicated or unless it is necessary to give effect to your transaction and then only with other professionals involved in the transaction. Please note that some of the information you have supplied may need to be shared with outside authorities for formal verification purposes (such as the Deeds Office, FIC, SARS, the Court or similar) and your signature of this form constitutes your permission for THE FIRM (BBB ATTORNEYS INC) to share the information accordingly.

COMPULSORY FICA QUESTIONNAIRE NATURAL PERSON/S

HAVE YOU PREVIOUSLY DEALT WITH THE FIRM (BBB ATTORNEYS INC) AND IF SO, PLEASE SUPPLY A SUMMARY

PARTY 1	PARTY 2

WHAT IS THE NATURE OF YOUR CURRENT INTERACTION WITH THE FIRM (BBB ATTORNEYS INC)

PARTY 1	PARTY 2

FULL NAMES

PARTY 1	PARTY 2

ID/PASSPORT NUMBERS

PARTY 1	PARTY 2

RSA RESIDENT PARTY 1

YES

RSA RESIDENT PARTY 2

YES

IF NON-RESIDENT, PLEASE CONFIRM THE PLACE OF PERMANENT RESIDENCY

PARTY 1	PARTY 2

RSA VISA ISSUED IF FOREIGN PARTY 1

YES

RSA VISA ISSUED IF FOREIGN PARTY 2

YES

INCOME TAX NUMBER

PARTY 1	PARTY 2

PLEASE CONFIRM TAX BASE IF NOT SOUTH AFRICA

PARTY 1	PARTY 2

MARITAL STATUS

PARTY 1	PARTY 2

ADDRESS (DOMICILIUM)

PARTY 1	PARTY 2

EMPLOYER

PARTY 1	PARTY 2

EMPLOYER CONTACT DETAILS

PARTY 1	PARTY 2

EMPLOYER ADDRESS

PARTY 1	PARTY 2

YOUR CONTACT NUMBER

PARTY 1	PARTY 2

YOUR CONTACT EMAIL

PARTY 1	PARTY 2

FICA QUESTIONS

These questions below are compulsory

MAIN OCCUPATION

PARTY 1	PARTY 2

INDUSTRY OF TRADE

PARTY 1	PARTY 2

OTHER INDUSTRIES OF TRADE

PARTY 1	PARTY 2

COUNTRIES OF TRADE

PARTY 1	PARTY 2

DO YOU HOLD INTEREST IN ANY ENTITY (COMPANY OR TRUST) REGISTERED IN SOUTH AFRICA OR ABROAD

PARTY 1	PARTY 2

PARTY 1	PARTY 2

ARE YOU INVOLVED IN ACTIVITIES DIRECLTY OR INDIRECTLY LINKED WITH THE MANUFACTURING OR SALE OF ARMS OR WEAPONS?

PARTY 1	PARTY 2

PLEASE CONFIRM WITH WHICH BANK YOU HOLD YOUR MAIN ACCOUNT?

PARTY 1	PARTY 2

PLEASE CONFIRM WHETHER YOU HOLD ANY BANK ACCOUNTS WITH BANKING INSTITUTIONS OUTSIDE OF SOUTH AFRICA?

Are you prepared to share the proof of your banking account if so requested? PARTY 1

YES

Are you prepared to share the proof of your banking account if so requested? PARTY 2

YES

ARE YOU A DOMESTIC OR FOREIGN POLITICALLY EXPOSED OR INFLUENTIAL PERSON OR A FAMILY MEMBER OR ASSOCIATE OF SUCH A PERSON *THIS WILL BE VERIFIED PARTY 1

YES

ARE YOU A DOMESTIC OR FOREIGN POLITICALLY EXPOSED OR INFLUENTIAL PERSON OR A FAMILY MEMBER OR ASSOCIATE OF SUCH A PERSON *THIS WILL BE VERIFIED PARTY 2

YES

INDIVIDUAL VERIFICATION DOCUMENTS

Copy of Green bar-coded South African ID/card or Passport if foreign and/or Residency VISA if applicable

Marriage Certificate and Antenuptial Agreement if applicable

Proof of Address (in the form of a utility bill, telephone account, lease agreement or alternatives issued by a 3rd party)

In addition to the above, please take note that we may require documentary proof for verification purposes at any stage of the transaction or business relationship of the following:

Tax Clearance/Official document from SARS confirming your Income Tax Number (if requested)

Proof of banking details

Proof of Source of Income

Information regarding your Source of Wealth (only if required)

DECLARATION: I confirm that all the information completed on this FICA questionnaire IS CORRECT and that I have truthfully completed all such questions. I confirm further that I do not trade in illegal activities.

Yes

PARTNERSHIPS

COMPULSORY FICA QUESTIONNAIRE PARTNERSHIPS

HAS ANY OF THE PARTNERS OR THE PARTNERSHIP ITSELF HAD PREVIOUS DEALINGS WITH THE FIRM (BBB ATTORNEYS INC)

PARTNERSHIP NAME the trading name or name by which the Partnership is commonly known

INCOME TAX & VAT NO.

ADDRESS OF EACH PARTNER

CONTACT NUMBER OF EACH PARTNER

PARTY 1	PARTY 2

CONTACT EMAIL

WHO ARE THE EXECUTIVE PARTNERS

FICA QUESTIONNAIRE

These questions below are compulsory

INDUSTRY OF TRADE

COUNTRIES OF TRADE

MAIN COUNTRY OF TRADE

MAIN INDUSTRY OF TRADE

OTHER INDUSTRIES OF TRADE

PLEASE CONFIRM WITH WHICH BANK THE PARTNERSHIP HOLDS ITS MAIN ACCOUNT?

YES

Please note that THE FIRM (BBB ATTORNEYS INC) will advise you of the METHOD by which the banking confirmation letter is to be sent for Data Privacy security purposes

PLEASE CONFIRM WHETHER THE PARTNERSHIP HOLDS ANY BANK ACCOUNTS WITH BANKING INSTITUTIONS OUTSIDE OF SOUTH AFRICA?

YES

Please note that THE FIRM (BBB ATTORNEYS INC) will advise you of the METHOD by which the banking confirmation letter is to be sent for Data Privacy security purposes

ARE ANY OF THE PARTNERS OR EXECUTIVE MANAGERS INVOLVED IN TRADING OF DUAL-USE GOODS SUBJECT TO EXPORT CONTROL OR IS THERE ANY CONNECTION WITH AN UNIVERSITY OR RESEARCH FACILITY INVOLVED IN THE RESEARCH OF DUAL-USE GOODS OR GOODS SUBJECT TO EXPORT CONTROL?

ARE ANY OF THE PARTNERS OR EXECUTIVE MANAGERS INVOLVED IN ACTIVITIES DIRECLTY OR INDIRECTLY LINKED WITH THE MANUFACTURING OR SALE OF ARMS OR WEAPONS?

ANY PARTNER A DOMESTIC OR FOREIGN Politically Exposed or Influential Person OR A FAMILY MEMBER OR ASSOCIATE OF SUCH A PERSON *This will be verified

YES

LIST ALL PRESENT PARTNERS’ FULL NAMES

PARTY 1	PARTY 2

LIST ALL PRESENT PARTNERS’ ID’S

PARTY 1	PARTY 2

LIST ALL AUTHORIZED REPRESENTATIVES’ NAME

PARTY 1	PARTY 2

LIST ALL AUTHORIZED REPRESENTATIVES’ ID

PARTY 1	PARTY 2

PLEASE CONFIRM THE OCCUPATION OF EACH PARTNER

PLEASE CONFIRM THE MAIN INDUSTRY OF TRADE FOR EACH PARTNER

PARTNERSHIP VERIFICATION DOCUMENTS Please take note that we require documentary proof for verification purposes of the following items (please tick item off if provided):

Resolution of Authorised Signatories

Copy of the Partnership Agreement Reflecting the Name of the Partnership

Proof of Identification for all Directors & Authorised Signatories

Proof of Address for all Directors & Authorised Signatories

We may also require documentary proof for verification purposes at any stage of the transaction or business relationship which may include the following items (please tick item off if provided):

Tax Clearance/Official document from SARS confirming your Income Tax Number

Proof of banking details

Proof of Source of Income (only if required)

Completion of the FICA questionnaire for individuals for any Director or Authorised Signatory to obtain additional information of such a person

DECLARATION: I confirm that all the information completed on both the PARTNERSHIP FICA questionnaire together with the information completed on this PARTNERSHIP Representative FICA questionnaire IS CORRECT and that I have truthfully completed all such questions. I confirm further that the PARTNERSHIP on whose behalf I am acting as Representative does not trade in illegal activities.

Yes

PARTNERSHIP EACH INDIVIDUAL PARTNER TO COMPLETE

HAVE YOU PREVIOUSLY DEALT WITH THE FIRM (BBB ATTORNEYS INC) AND IF SO, PLEASE SUPPLY A SUMMARY

PARTY 1	PARTY 2

WHAT IS THE NATURE OF YOUR CURRENT INTERACTION WITH THE FIRM (BBB ATTORNEYS INC)

PARTY 1	PARTY 2

FULL NAMES

PARTY 1	PARTY 2

ID/PASSPORT NUMBERS

PARTY 1	PARTY 2

RSA RESIDENT PARTY 1

YES

RSA RESIDENT PARTY 2

YES

IF NON-RESIDENT, PLEASE CONFIRM THE PLACE OF PERMANENT RESIDENCY

PARTY 1	PARTY 2

IF FOREIGN, PLACE OF BIRTH

PARTY 1	PARTY 2

RSA VISA ISSUED IF FOREIGN PARTY 1

YES

RSA VISA ISSUED IF FOREIGN PARTY 2

YES

INCOME TAX NUMBER

PARTY 1	PARTY 2

PLEASE CONFIRM TAX BASE IF NOT SOUTH AFRICA

PARTY 1	PARTY 2

MARITAL STATUS

PARTY 1	PARTY 2

ADDRESS (DOMICILIUM)

PARTY 1	PARTY 2

EMPLOYER

PARTY 1	PARTY 2

EMPLOYER CONTACT DETAILS

PARTY 1	PARTY 2

EMPLOYER ADDRESS

PARTY 1	PARTY 2

YOUR CONTACT NUMBER

PARTY 1	PARTY 2

YOUR CONTACT EMAIL

PARTY 1	PARTY 2

FICA QUESTIONS

These questions below are compulsory

MAIN OCCUPATION

PARTY 1	PARTY 2

INDUSTRY OF TRADE

PARTY 1	PARTY 2

OTHER INDUSTRIES OF TRADE

PARTY 1	PARTY 2

COUNTRIES OF TRADE

PARTY 1	PARTY 2

DO YOU HOLD INTEREST IN ANY ENTITY (COMPANY OR TRUST) REGISTERED ABROAD

PARTY 1	PARTY 2

PARTY 1	PARTY 2

ARE YOU INVOLVED IN ACTIVITIES DIRECLTY OR INDIRECTLY LINKED WITH THE MANUFACTURING OR SALE OF ARMS OR WEAPONS?

PARTY 1	PARTY 2

ARE YOU A DOMESTIC OR FOREIGN POLITICALLY EXPOSED OR INFLUENTIAL PERSON OR A FAMILY MEMBER OR ASSOCIATE OF SUCH A PERSON *THIS WILL BE VERIFIED PARTY 1

YES

ARE YOU A DOMESTIC OR FOREIGN POLITICALLY EXPOSED OR INFLUENTIAL PERSON OR A FAMILY MEMBER OR ASSOCIATE OF SUCH A PERSON *THIS WILL BE VERIFIED PARTY 2

YES

INDIVIDUAL VERIFICATION DOCUMENTS

Copy of Green bar-coded South African ID/card or Passport if foreign and/or Residency VISA if applicable

Marriage Certificate and Antenuptial Agreement if applicable

Proof of Address (in the form of a utility bill, telephone account, lease agreement or alternatives issued by a 3rd party)

In addition to the above, please take note that we may require documentary proof for verification purposes at any stage of the transaction or business relationship of the following:

Tax Clearance/Official document from SARS confirming your Income Tax Number (if requested)

Proof of banking details

Proof of Source of Income

Information regarding your Source of Wealth (only if required)

Yes

Test page

ALTERNATIVE JURISTIC PERSONS

ALTERNATIVE JURISTIC PERSONS INDIVIDUAL REPRESENTATIVE/S TO COMPLETE

DECEASED ESTATE

FOREIGN COMPANIES

FICA QUESTIONNAIRE

PLEASE CONFIRM WITH WHICH BANK THE COMPANY HOLDS ITS MAIN ACCOUNT?

PLEASE CONFIRM WHETHER THE COMPANY HOLDS ANY BANK ACCOUNTS WITH BANKING INSTITUTIONS IN ANY OTHER COUNTRY?

SHAREHOLDING

COMPANY VERIFICATION DOCUMENTS

FOREIGN COMPANY INDIVIDUAL REPRESENTATIVE/S TO COMPLETE

SHAREHOLDERS’ DECLARATION:

TRUSTS

COMPULSORY FICA QUESTIONNAIRE TRUSTS

TRUST INDIVIDUAL REPRESENTATIVE/S TO COMPLETE

COMPULSORY FICA QUESTIONNAIRE COMPANIES / CLOSE CORPORATIONS

FICA QUESTIONNAIRE

SHAREHOLDING

COMPANY VERIFICATION DOCUMENTS

CLOSE CORPORATION VERIFICATION DOCUMENTS

FICA QUESTIONS

SHAREHOLDERS’ DECLARATION

INDIVIDUALS

COMPULSORY FICA QUESTIONNAIRE NATURAL PERSON/S

FICA QUESTIONS

PARTNERSHIPS

COMPULSORY FICA QUESTIONNAIRE PARTNERSHIPS

FICA QUESTIONNAIRE

PARTNERSHIP EACH INDIVIDUAL PARTNER TO COMPLETE

FICA QUESTIONS

Location

Phone

Email

Working Hours

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