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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

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ALTERNATIVE JURISTIC PERSONS

ALTERNATIVE JURISTIC PERSONS INDIVIDUAL REPRESENTATIVE/S TO COMPLETE

DECEASED ESTATE

Location

Phone

Email

Working Hours

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