Annexure A
General information on completion of questionnaires as contained in Annexures B and C
A – Instructions for completion and submission
1.The questionnaires in Annexure B and C must be properly completed and Annexure D must be signed by all applicants who have completed either Annexure B or C. Questions must be answered either in full or indicated not applicable ("n/a"). The signatory(ies) of the questionnaires must be duly authorised to furnish the information.2.The questionnaires in Annexure B and C must be completed in respect of directors and senior managers as indicated therein.3.The format of the questionnaire or the wording of questions may not be changed. However, this document may be reproduced.4.Answers may be in handwriting or in typewriting.4.1.If the questionnaire is completed electronically (a) the solid lines in those areas provided for answers must be deleted before the answers are typed or alternatively the overtype mode whilst the answers are typed must be used; and (b) rows may be inserted where insufficient space is provided for answers.4.2.If the questionnaire is completed in writing and the space provided is not sufficient, the detail may be provided on a separate page, duly cross-referenced to the relevant question. Please indicate the number of any supplementary sheets attached to Annexures B and C.4.3.If the questionnaire submitted contains any changes to typed or written information, such changes must be duly signed.5.Applications must be submitted to the Registrar of Securities Services at one of the following addressesP O Box 35655Menlo Park0102Facsimile: (012) 346-6533 | 41 Matroosberg RoadRiverwalk Office ParkBlock BAshlea Gardens Ext 60081 |
Annexure B
Questionnaire to be completed in respect of directors and senior managers of an applicant
Annexure C
Questionnaire to be completed in respect of an applicant
Annexure D
Declaration
I, the undersigned, hereby certify that, to the best of my knowledge, the information given in 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 senior manager of the market infrastructure, 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 to 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, 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 its 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.Position held:SIGNATUREDATEDocuments to be submitted
a certified copy of the RSA identity document, or Passport;completed and signed Personal Credential Verification Forms;the curriculum vitae;the credit reference for the applicant;the credit reference of the director or senior manager;the signed declaration; andthe other documents, if any, mentioned in questions in support of the information contained in this document.