Companies and close corporations

COMPULSORY FICA QUESTIONNAIRE - COMPANIES / CLOSE CORPORATIONS

HAS THE COMPANY OR CLOSE CORPORATION OR ANY OF ITS DIRECTORS, SHAREHOLDERS OR MEMBERS PREVIOUSLY DEALT WITH THE BUSINESS (THE ACUMEN GROUP) AND IF SO, PLEASE SUPPLY A SUMMARY

WHAT IS THE NATURE OF THE COMPANY OR CLOSE CORPORATION’S INTERACTION WITH THE BUSINESS (THE ACUMEN GROUP)

REGISTERED NAME

TRADING NAME

REGISTRATION NUMBER

INCOME TAX & VAT NO.

NATURE OF BUSINESS

REGISTERED ADDRESS

Street Address City State / Province / Region ZIP / Postal Code Country

TRADING ADDRESS

Street Address City State / Province / Region ZIP / Postal Code Country

MAIN CONTACT NUMBER

MAIN CONTACT EMAIL

IS THE COMPANY AN ACCOUNTABLE INSTITUTION?

Yes

No

SHAREHOLDING

Please confirm the details of 100% of the shareholders

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)

Please provide proof thereof

COMPANY / CLOSE CORPORATION’S EXECUTIVE MANGERS

PLEASE CONFIRM THE OCCUPATION OF EACH DIRECTOR, SHAREHOLDER OR MEMBER

DIRECTOR, SHAREHOLDER OR MEMBER

OCCUPATION

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

DIRECTOR, SHAREHOLDER OR MEMBER

INDUSTRY/INDUSTRIES OF TRADE

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

Please note that all shareholding companies/close corporations must disclose their own shareholding and ownership structures separately and each such juristic persons will be required to complete their own FICA questionnaire

COMPANY / CLOSE CORPORATION - INDIVIDUAL REPRESENTATIVE/S TO COMPLETE

HAVE YOU PREVIOUSLY DEALT WITH THE BUSINESS (THE ACUMEN GROUP) AND IF SO, PLEASE SUPPLY A SUMMARY

Party 1

Party 2

WHAT IS THE NATURE OF YOUR CURRENT INTERACTION WITH THE BUSINESS (THE ACUMEN GROUP)

Party 1

Party 2

FULL NAMES

Party 1

Party 2

ID/PASSPORT NUMBERS

Party 1

Party 2

RSA RESIDENT

Party 1 (Yes/No)

Party 2 (Yes/No)

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

Party 1

Party 2

DO YOU HOLD AMERICAN CITIZENSHIP OR RESIDENCY

Party 1 (Yes/No)

Party 2 (Yes/No)

IF FOREIGN, PLACE OF BIRTH

Party 1

Party 2

RSA VISA ISSUED IF FOREIGN

Party 1 (Yes/No)

Party 2 (Yes/No)

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 DETAILS

Party 1

Party 2

EMPLOYER

Party 1

Party 2

CONTACT NUMBER

Party 1

Party 2

CONTACT EMAIL

Party 1

Party 2

FICA QUESTIONS

Customer/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 customer/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

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 TRADING 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 IN ACTIVITIES DIRECLTY OR INDIRECTLY LINKED WITH THE MANUFACTURING OR SALE OF ARMS OR WEAPONS?

Party 1

Party 2

YOUR MAIN SOURCE OF WEALTH

Party 1

Party 2

PLEASE CONFIRM YOUR GENERAL SOURCE OF FUNDS

*Source of Income or Wealth means the activities that have generated the total net worth of your wealth. Example inheritance or savings, salary, inheritance, pension, proceeds of sale, divorce settlement, company profits, investment maturing, private capital raise, sale of shares, bursary

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

Uploaded Documents

Drop files here or

Max. file size: 16 MB.

Uploaded 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)

Uploaded Documents

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 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.

Signature

Date

FINANCIAL INTELLIGENCE CENTRE ACT RISK MANAGEMENT AND COMPLIANCE PROGRAMME (RMCP)

COMPULSORY FICA QUESTIONNAIRE - COMPANIES / CLOSE CORPORATIONS

FICA QUESTIONNAIRE

SHAREHOLDING

COMPANY VERIFICATION DOCUMENTS

CLOSE CORPORATION VERIFICATION DOCUMENTS

DECLARATION

COMPANY / CLOSE CORPORATION - INDIVIDUAL REPRESENTATIVE/S TO COMPLETE

FICA QUESTIONS

INDIVIDUAL VERIFICATION DOCUMENTS

DECLARATION

CONTACT

Let’s work together info@acumengroup.co.za

Services

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