Section 1: Beneficial Ownership Register Entry
Please complete the below fields for the Entry that should appear on the Entity’s Register.
The term “Entry” is used below as a general reference to the individual(s) or legal person(s) that you have selected to appear on the Entity’s Register. To determine the Entry, except where the Entity itself is regulated, you must identify an individual or legal person which directly or indirectly owns 25% of the shares or otherwise has control of the Entity that falls into one of the categories listed within the Type of Entry section. Indirect ownership is captured by performing this exercise at each level of the structure until an Entry is found. If, after this analysis is performed, there are no qualifying individuals or legal persons, a senior managing official of the Entity should be chosen. The Act defines the meaning of beneficial owner and can assist with the classification.
Section 2: Contact Person Information
Please provide information for the Contact Person
if the “Type of Entry” in
Section 1 is one of the following: a Corporate Foreign Trustee;
Liquidator/Receiver or a Fund regulated in the Cayman Islands under the Private
Funds Act or Mutual Funds Act.
Section 3: Alternate Routes to Compliance
Listed on an Approved Stock Exchange
If the “Type of Entry” in Section 1 is “Listed on an Approved Stock Exchange” or its subsidiary, please complete the following.
Regulated in the Cayman Islands
If the “Type of Entry” in Section 1 is “Fund Regulated in the Cayman Islands” or “Other Entity Regulated in the Cayman Islands”, please complete the following.
Section 4: Additional Entries
Each form can accommodate up to 2 additional entries. If you need to add more than 2 entries, please fill out a new form for the extra entries.
Appendix 1
Section 1: Beneficial Ownership Register Entry
Please complete the below for the Registrable Beneficial Owner (individual or Reportable LegalEntity), corporate trustee or the legal person that qualifies for an Alternative Route to Compliance(together, the “Entry”) that should appear on the Entity’s Register:
Section 2: Contact Person Information
Please provide information for the Contact Person if the “Type of Entry” in Section 1 is one of the following: a Corporate Foreign Trustee; Liquidator/Receiver or a Fund regulated in the Cayman Islands under the Private Funds Act or Mutual Funds Act. Otherwise, put “N/A”.
Section 3: Alternate Routes to Compliance
Listed on an Approved Stock Exchange
If the “Type of Entry” in Section 1 is “Listed on an Approved Stock Exchange” or its subsidiary, please complete the following.
Regulated in the Cayman Islands
If the “Type of Entry” in Section 1 is “Fund Regulated in the Cayman Islands” or “Other Entity Regulated in the Cayman Islands”, please complete the following.
Appendix 1
Section 1: Beneficial Ownership Register Entry
Please complete the below for the Registrable Beneficial Owner (individual or Reportable LegalEntity), corporate trustee or the legal person that qualifies for an Alternative Route to Compliance(together, the “Entry”) that should appear on the Entity’s Register:
Section 2: Contact Person Information
Please provide information for the Contact Person if the “Type of Entry” in Section 1 is one of the following: a Corporate Foreign Trustee; Liquidator/Receiver or a Fund regulated in the Cayman Islands under the Private Funds Act or Mutual Funds Act. Otherwise, put “N/A”.
Section 3: Alternate Routes to Compliance
Listed on an Approved Stock Exchange
Section 3: Alternate Routes to Compliance (if applicable)
If the “Type of Entry” in Section 1 is “Listed on an Approved Stock Exchange” or its subsidiary, please complete the following. Otherwise, put “N/A”.
Regulated in the Cayman Islands
If the “Type of Entry” in Section 1 is “Fund Regulated in the Cayman Islands” or “Other Entity Regulated in the Cayman Islands”, please complete the following. Otherwise, put “N/A”.
Section 5: Required Particulars
Required Particulars are necessary for all Entries. If not already provided, Highvern will request the appropriate supporting documentation, including identification, proof of address, formation documents and/or registers.
What are Required Particulars?
The required particulars of an individual […] are — (a) full legal name; (b)
residential address; (c) an address for service of notices under this Act;
(d) date of birth; (e) nationality; (f) information from the individual’s
unexpired and valid passport, driver’s licence or other government-issued
document that identifies the individual including — (i) identification
number; (ii) country of issue; and (iii) date of issue and of expiry; (g)
nature in which the individual owns or exercises control of the legal
person; and (h) the date on which the individual became or ceased to be a
registrable beneficial owner in relation to the legal person in question.
The required particulars of [a Deemed Beneficial Owner] are — (a) name; (b)
principal office; (c) the legal form of the individual and the law by which
the individual is governed; and (d) the date on which the individual became
or ceased to be registrable beneficial owner in relation to the legal person
in question.
The required particulars of a reportable legal entity are — (a)
corporate or firm name; (b) registered or principal office; (c) the legal
form of the entity and the law by which it is governed; (d) the nature of
the reportable legal entity’s ownership or its exercise of control of the
legal person; (e) the register in which it is entered and its registration
number in that register; and (f) the date on which it became or ceased to be
a registrable beneficial owner in relation to the legal person in question.
Section 6: Declaration
I hereby confirm that this form serves as written confirmation of the Entity’s
Registrable Beneficial Owner(s)or Alternative Route to Compliance and
corresponding Required Particulars, in accordance with Section 12 of the Act
and that:
- All of the information contained in this form is accurate and that should
there be any change in the information I will inform Highvern immediately;
- I agree and acknowledge, on behalf of the Entity, that the Entity will
provide Highvern with such additional information, as is required by the Act
and/or the Regulations (as applicable) to the extent any Required
Particulars in this confirmation ceases to be true, are inaccurate or
incomplete, as outlined in the Terms of Business;
- Highvern shall be able to rely on the accuracy of the information in this
form without further enquiry;
- I confirm that accurate, current Required Particulars corresponding to
the entries above, will be, or previously have been, provided to Highvern
Cayman Limited (“Highvern”)to fulfil the Register obligations of the Entity;
- Highvern shall bear no responsibility or liability in relation to any
Beneficial Ownership Register created as a result of the information
contained in this form;
- I acknowledge that there are administrative fines which can be levied
against the Entity for submitting false information or failure to provide
information, as prescribed in Section 26 of the Act and Schedule 1 of the
Monetary Authority Administrative Fines Regulations as amended from time to
time;
- I hereby agree on behalf of the Entity to hold harmless and fully
indemnify Highvern and its directors and officers for any and all loss,
expenses, costs (including legal fees) or fines arising out of any
misleading, inaccurate or false information supplied to Highvern by or on
behalf of the Entity for the purposes of filing the Required Particulars;
and
- I further confirm that I have read and understand the Privacy Policy.
I hereby instruct Highvern, as the Entity’s registered office, to file the
Required Particulars for each Registrable Beneficial Owner or Entity
qualifying for Alternative Route to Compliance contained herein with the
Competent Authority on behalf of the Entity, in accordance with Section 13 of
the Act, in such form and manner as prescribed by the Competent Authority.
The information you provide in response to this form will be processed for the
purposes described above, in accordance with the General Data Protection
Regulation and/or equivalent Data Protection legislation depending on the
relevant jurisdiction. For more information about how we process your data,
please see Highvern’s privacy statement which can be found at www.highvern.com/privacy-statement/ Where you are providing information
relating to other data subjects, you confirm that you have obtained the
necessary informed consent for such disclosure.
Required fields are marked *. Conditional sections appear based on your answers. See our privacy notice for how we process your information.
