Regulatory Information Request

As the Registered Office provider, we would need to file the Economic Substance Notification to the Cayman Islands Tax Information Authority, also known as the Department for International Tax Cooperation (“DITC”), in accordance with International Tax Co-operation (Economic Substance) Act and Economic Substance Guidance. In order to make these notifications, which covers the Company’s current financial year, or a resubmission of the prior year, we should be grateful if an authorized representative would complete the questionnaire below.

An Economic Substance Notification is required annually in order to file the Company’s Annual Return.

Our intention is to complete future notifications, based upon the information provided this year. Therefore, in future years we will only need you to advise us of any changes that may affect the filings.

If the Company is classified as a relevant entity, carrying on relevant activities, the Company will be required to also submit an Economic Substance Return, which provides additional details on the activities of the Company during its financial year.

This form also captures the “Entity’s Nature of Business”, which is reported to the Registrar of Companies. If your nature of business has not changed since incorporation, please select the same classification that was selected at incorporation.

Incorporation/Registration Number

Client Name

CAP Nature of Business Guidances

Entity’s Financial Year Commencement (dd-mm)

Entity's Financial Year End (dd-mm)

Economic Substance Notification Year (yyyy)

Did the entity carry on a Relevant Activity, as defined in the ES Act, as amended during the year?

Yes No

What was the Relevant Activity (select multiple, if applicable)?

Banking Business Distribution and Service Centre Business Financing and Leasing Business Fund Management Business Headquarters Business Holding Company Business Insurance Business Intellectual Property Business Shipping Business

Is the entity an Investment Fund?

Yes No

Does the CIMA, FI and/or GIIN information provided below belong to another investment fund that directly or indirectly invests or operates through the entity?

Yes No

Name of Investment Fund

Jurisdiction of Investment Fund

Please complete one or more of the below fields. If you do not have a number, please confirm by clicking the appropriate box.

Confirm the entity does not have a CIMA Type and Number

CIMA Type

CIMA Number

Financial Institution

FI Number.

Confirm the entity does not have the FI Number.

IRS GIIN

Confirm the entity does not have the IRS GIIN.

Is this a confirmed Relevant Entity, as defined in the ES Act, as amended during the year?

Yes No

Which exemption does it qualify for?

Tax resident in another jurisdiction A domestic company Local Partnership

Economic Substance Return Requirement:

By virtue of the fact that the Company submitted an Economic Substance Notification confirming that it undertook a Relevant Activity above, an Economic Substance Return will need to be submitted through the DITC Portal by a Director of, or otherwise an authorized person on, the entity. This is due one year from the date of the entity’s financial year end.

Please may you provide the name, contact email and position of the person who you would like to be assigned to complete this submission below:

Contact First Name

Contact Last Name

Contact Email

Contact Position

Once Highvern Cayman Limited receives this submission, you will be assigned as the Secondary User through the DITC Portal. The person detailed above will receive an “Email Register Notification” email from no-reply@ditc.ky. To activate your ‘User’ account, please follow the instructions contained within the email. If you have not received this email, you may wish to check your spam folder and filters. Once activated, you will be able to complete the required Economic Substance Return, for this, and all future years. Instructions on how to do this are contained within the DITC Portal User Guide.

Please be aware that as a part of this submission the Company will be required to upload financial statements or books of account. It is worth noting that Section 7 of the Cayman Islands International Tax Co-Operation (Economic Substance) Act (“ES Act”) indicates that if the Company fails to provide the required information within the specified timeframe, it could incur a fine of CI$10,000.

Once you have successfully completed the Economic Substance Return, please send me a PDF copy of the submission, together with the financial statements upon which the filings were made, so they may be saved with the Company’s records.

(A domestic company) Which exemption does it qualify for?

Confirm the entity is not part of the MNE Group, is only carrying on business in the Islands and licensed under S3(a) of the Trade and Business Licensing Act (“TBL”) Confirm the entity is not part of the MNE Group, is only carrying on business in the Islands and licenced under Section 4(1) of the Local Companies Control Licensing Act. Confirm the entity is not part of an MNE Group and is a company referred to in Section 80 of the Companies Act, as amended.

(Local Partnership) Which exemption does it qualify for?

Confirm that the entity is a partnership as defined under section 3 of the Partnership Act (Revised) that is not part of an NINE Group and that is only carrying on business in the islands and is empowered by its partnership agreement to carry on business and that is licensed under the Trade and Business Licensing Act (Revised) and at the relevant time is carrying on such business in accordures with the terms and conditions imposed in such litence and not otherwise. Confirm that the entity is a partnership as defined under section 3 of the Partnership Act (Revised) that is not part of an. MiNE Group and that is only carrying on business in the islands and is empowered by its partnership agreement to carry on business and that is operating under a franchise granted by the government. Confirm that the entity is a partnership as defined under section of the Partnership Act (Revised) that is not part of an MNE Group and that is only carrying on business in the islands and is empowered by its partnership agreement to carry on business and complies with section 3(a) of the Trade and Business Licensing Act (Revised).

Date Franchise Granted Cayman Islands Government

Is this a not for profit company?

Yes No

Type of License

Licence/Reference/Registration #

Financial Statements or Books of Account

Please provide financial statements or books of account to your HCL contact. It is a requirement under the Companies Act that Financial Statements/Books of Account are held at the registered office.

Disclaimer

As a director or authorized signatory of the Entity, I hereby authorise Highvern to file the Entity’s Economic Substance Notification with the Tax Information Authority and Nature of Business with the Registrar of Companies, or any other authority as may be required by Act, based on the information provided in this submission. I understand that Highvern will use this information on an ongoing annual basis unless advised otherwise, and I undertake to advise Highvern promptly in the event of any changes to this information. I acknowledge and accept there are sanctions for providing inaccurate information and I confirm that the entity will indemnify Highvern for any liability that may result from the submission of inaccurate information. I also acknowledge Highvern makes the submission without undertaking any investigation or verification of the information provided.

Name

Field 10

By submitting this notification to the Tax Information Authority (TIA), the entity acknowledges that there are sanctions as outlined in section 13(2) of the ES Act for Providing inaccurate information to the TIA.

Regulatory Information Request

Complete the form

Financial Statements or Books of Account

Disclaimer

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