COMPANY DETAILS
Name of Company
Does the trading name differ? If "yes", indicate trading name:
Registration number
Office contact number
Email address
Office physical address
Head office physical address
Website address
Is the Company listed on a stock exchange? If "yes", indicate the exchange:
PERSON COMPLETING FORM ON BEHALF OF COMPANY
Full name
Identity Number
Authority
Resolution
Letters of Authority
Power of Attorney
COMPANY STRUCTURE
Nature of business of the Company (industry / products / services)
What is the Company’s ownership and control structure?This question is about whether Client has a fairly simple ownership structure in terms of which assets are directly owned or controlled by an easily determinable number of natural persons or whether the Client is part of a more complex structure, in terms of which it is not as easy to determine the natural persons who directly own and control the Client's assets.
Names of natural persons who individually or collectively ultimately own a majority (5%) of the Company's shares.The ultimate beneficial owners or controllers are the natural persons who, individually or acting together, ultimately own 5% or more of the shares of the company, or otherwise control the company (for instance through a shareholders agreement). Example, if Company A is 5% owned by Company B, and Company B is in turn 100% owned by Joan Smith, then Joan Smith is the ultimate beneficial owner of Company A, even though she is not the legal owner of the 5% stake in Company A.
Names of natural persons who individually or collectively control the Company (have a material influence on the Company operations?
Names of Executive Managers
Source of income of Company
Source of capital wealth of Company
Will any payment to Trust involve a cash payment of R50 000 or more?
Will any payment to Trust involve an International Funds Transfer of R20 000 or more?
Does the source of funds relate to a virtual currency transaction (e.g. Bitcoin)?
FAMILY DETAILS
Do any of the Ultimate Beneficial Owners, their immediate family or close associate, now occupy, or have in the past 12 months occupied, any of the following positions in South Africa? President or Deputy President of South Africa Cabinet or Deputy Minister Premier of a Province MEC of a Province Leader of a Political Party Member of a Royal Family Senior Traditional Leader Head, Accounting Officer or CFO of a National or Provincial Department Manager or CFO of a Municipality Chairperson, CEO, Accounting Authority, CFO or Chief Investment Officer of a Public Entity Judge Ambassador, High Commissioner, other Senior Representative of a Foreign Country based in South Africa Chairperson of Board of Directors or Audit Committee, Executive Officer or CFO of company doing more than the Gazetted amount’s worth of business with the government
Do any of the Ultimate Beneficial Owners, their immediate family or close associate, now occupy, or have in the past 12 months occupied, any of the following positions in any country outside South Africa? Head of state Member of a royal family Cabinet member Senior member of a political party Senior judicial officer Senior executive of a state-owned entity High ranking member of the military
If you responded “Yes” to the above questions, please indicate the position that you, your immediate family member or close associate hold or held and the source of your / their wealth.
Full name
Position held
Date held from
Source of Wealth
The immediate family member is:
Spouse, life partner or previous spouse
Children, step-children and their spouses
Parents, siblings, step siblings and their spouses.
The following copies should be sent via
WhatsApp or email at
property@steenkampinc.com :
1. Certificate of Incorporation (with Registrar of Companies Stamp)
2. Any document reflecting the trade name of the Company
3. Notice of Directors
4. Notice of Auditor
5. Notice of Registered Address
6. SARS Tax Registration document of the Company
7. VAT Registration Certificate of Company (if applicable)
8. ID’s of Directors, mandated officials acting on behalf of Company and Shareholders holding more than 5% shareholding
9. Shareholders Certificates for Shareholders holding more than 5% shareholding in the Company
10. Proof of residential address of such persons not older than 3 months
Note: according to the Act we cannot proceed until your risk rating has been assessed and approved, therefore, please provide us with these documents as soon as possible.
DIRECTORS FICA FORM
This section should be completed by all Directors and representatives acting on behalf of the Company.
Full name
Identity Number (Date of birth / Passport no. if Foreign)
Are you a South African citizen / permanent resident? Country (if not SA)
Were you born in any of the following countries / jurisdictions or affiliate? DPRK (North Korea) Democratic Republic of Congo Guinea-Bissau Iran Iraq Lebanon Libya Mali Somalia Eritrea South Sudan Sudan Yemen ISIL (Da’esh) Al-Qaida The Taliban
Address of main place of residence
Contact number
Email address
Do you, your immediate family or close associate, now occupy, or have in the past 12 months occupied, any of the following positions in any country outside South Africa? Head of state Member of a royal family Cabinet member Senior member of a political party Senior judicial officer Senior executive of a state-owned entity High ranking member of the military
Do you, your immediate family or close associate, now occupy, or have in the past 12 months occupied, any of the following positions in any country outside South Africa? President or Deputy President of South Africa Cabinet or Deputy Minister Premier of a Province MEC of a Province Leader of a Political Party Member of a Royal Family Senior Traditional Leader Head, Accounting Officer or CFO of a National or Provincial Department Manager or CFO of a Municipality Chairperson, CEO, Accounting Authority, CFO or Chief Investment Officer of a Public Entity Judge Ambassador, High Commissioner, other Senior Representative of a Foreign Country based in South Africa Chairperson of Board of Directors or Audit Committee, Executive Officer or CFO of company doing more than the Gazetted amount’s worth of business with the government
If you responded “Yes” to the above questions, please indicate the position that you, your immediate family member or close associate hold or held and the source of your / their wealth.
Full name
Position held
Date held from
Source of Wealth
The immediate family member is:
Spouse, life partner or previous spouse
Children, step-children and their spouses
Parents, siblings, step siblings and their spouses.
POPI CONSENT
Submit
