Private Securities Commission
1. Company Name
2. Type of Entity CompanyBank/Insurance/Gaming/Betting
3. Nature of Business TradingInvestment HoldingOthers
4. Beneficial Owners Full Name
Residential Address (Not P.O Box)
Date of Birth
Place of Birth
5. Capital Structure Issued
6. Name of Shareholder
Class of Shares
No. of Shares
7. Directors Local DirectorsOther Non- Resident Directors
8. Source of Funds ProprietaryNon-ProprietaryNon-ProprietaryOthers
9. Initial Due Diligence Identification: A certified true copy of the relevant passport pages or identity card of each beneficial owner.Profile: A brief Business/Professional profile (track record) of each beneficial ownerProof of Address: A certified copy or Original of a document (e.g. Bank Statement, Utility Bill) of each Beneficial Owner as proof of residential addressReferences: A Bank/Professional Letter of reference, in original, in favour of each of the beneficial owner including his/her residential address, addressed to Comoros Financial Services Ltd.If Holding Company (i.e. where shares by a holding company): Where shareholder is a body Corporate, Certified copy of Cert. of Inc and M&A. Details of Registered Office and Principal place of Business and directors, shareholders. Recent set of accounts and Resolution approving Investment/shareholding as appropriate. Any corporate brochures.
10. I/We certify and confirm, to the best of my/our knowledge and belief, that the above information (including annexure) is complete and that the above Beneficial Owners have taken the appropriate legal, tax, exchange control and relevant professional advice in the particular circumstances. I/We further certify and confirm, to the best of my/our knowledge and belief, that none of the above Beneficial Owners, directors or officers of the Company has ever been convicted in a Court of Law for a criminal offence, penalized, sanctioned, is currently or has ever been under investigation for professional negligence or malpractice by any regulatory authority in any country. I/We also undertake that no transactions or documents will be entered into until notified in writing to Private Securities Commission International Finance Authority laws that all relevant consents have been obtained and that the proposed company may commence trading. I/We further undertake to enter into the standard company management agreement in respect of Private Securities Commission International Finance Authority laws management of the Company. I/We, acknowledge having taken full cognizance and understood the fees and accept them. I/We confirm we have no objection in Private Securities Commission International Finance Authority laws either directly of via a third party using any credit reference agency to obtain any information on the directors, shareholders and /or beneficial owners.