Institutional Questionnaire – Pension Commission Bermuda

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Please read the questions carefully. If more space is needed the answers should be written in the space provided at the back of this questionnaire headed “Additional Information.” Clearly state to which question the details relate. Answers should be written in ink in BLOCK CAPITALS or typed. When you return these forms please ensure you enclose copies of the entity’s Memorandum of Association and By-Laws, as well as the financial information requested in question A. 15 of this questionnaire.

The areas covered in this questionnaire are not exhaustive of the matters that the Pension Commission will consider in assessing whether an entity is “Fit and Proper.”

A

1. Name of the applicant seeking approval as a pension plan administrator under the National Pension Scheme (Occupational Pensions) Act 1998.*

2. Name of the entity (hereinafter “Entity”) to which this questionnaire relates.*

3. Please state the corporate name and any business name(s) used for the purposes of or in connection with any business carried on by the Entity.*

4. Description of the Entity’s business.*

5. Any former name(s) under which the Entity has been registered or has traded.

6. Country and date of incorporation of the Entity.

7. Registered address of the Entity and principal place of business (if different).

8. Name(s) and address (es) of the Entity’s principal bankers within the last 10 years.

9. Name and position of all directors of the Entity.

10. How many shares/how many share holder and what % of voting power in the Entity is registered in the name of the each shareholder?

11. Are any of the shares/is any % of voting power in the Entity mentioned in answer to Question 10 above equitably or legally charged or pledged to any party? If so give full particulars.

12. Does the Entity hold, or has it ever held any authorization from a supervisory or regulatory body to carry on any business in Bermuda or elsewhere? If so give full particulars.

13. Has the Entity or any related company ever applied for any authorization from a supervisory or regulatory body to carry on business in Bermuda or elsewhere other than an authorization already mentioned in answer to Question 12?

14. Please provide audited accounts for the entity (and where appropriate, audited group accounts for the controller’s group) for the last three financial years (if available). If the most recent audited accounts are more than six months out of date, they should be accompanied my management accounts (which need not be audited) showing the current financial position and the current results of the Entity.

B.

Please answer Yes or No to the following questions. If any of the answers to the questions below are yes, please give full particulars in the space provided at the back of this questionnaire clearly stating to which question the details relate.

a. Has the Entity at any time been associated in any way with any institution whose licence to conduct any financial services business has during the period of the Entity’s involvement or within 12 months thereafter, been revoked, cancelled, restricted, suspended or surrendered under any law?*

Yes

b. Has the Entity at any time been associated in any way with any institution whose application for a licence to conduct investment business or other financial services business in Bermuda or elsewhere has during the period of your involvement or within 12 months thereafter, been refused or withdrawn?*

Yes

c. Has the Entity at any time been convicted of any offence by any court, in Bermuda or elsewhere? If so, when giving particulars detail the court by which the Entity was convicted, the offence, the penalty imposed and the date of conviction?*

Yes

d. Has the Entity, in Bermuda or elsewhere, been censured, disciplined or criticized by any professional body to which it belongs or had belonged or made the subject of a court order at the instigation of any regulatory authority ?*

Yes

e. Has the Entity, or has any company, partnership or unincorporated institution with which the Entity is associated in any way with, or associated with, by reason of any matters relating to it at a time when the Entity was so associated, been the subject of an investigation, in Bermuda or elsewhere, by a governmental, professional or other regulatory body?*

Yes

f. Has the Entity incurred a judgment under an order of a court in Bermuda or elsewhere or made any compromise arrangement with its creditors within the last 10 years?*

Yes

g. Has any company, partnership or unincorporated institution with which the Entity was associated with in Bermuda or elsewhere been wound up or otherwise made any compromise or arrangement with its creditors or ceased trading, either when the Entity was associated with it or within one year after it ceased to be associated with it? Has anything analogous to any of these events occurred under the laws of any other jurisdiction?*

Yes

h. Has the Entity been concerned with the management or conduct of affairs of any institution which, by reason of any matter relating to it at a time when the Entity was so concerned, been censured, warned as to future conduct, disciplined or publicly criticised by or made the subject to a court order at the instigation of any regulatory authority in Bermuda or elsewhere?*

Yes

i. Has the Entity, in connection with the formation or management of any body corporate, partnership or unincorporated institution, been held by a court in Bermuda or elsewhere to have civil liability for any fraud, misfeasance or other misconduct by the Entity towards such a body or company or towards any members thereof?*

Yes

j. Is the Entity presently engaged or expected to be engaged in any litigation in Bermuda or elsewhere?*

Yes

CERTIFICATION

I certify that the above information is complete and correct to the best of my knowledge and belief.

Signature

Date*

DD dash MM dash YYYY

Email*

Name

Title/Position:

ADDITIONAL INFORMATION

(Please state clearly to which questions the details relate)

A

CERTIFICATION

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