The applicant officer must complete the following questionnaire by providing yes/no responses.
1. Have you ever been convicted of a criminal offence or an offence under legislation (whether or not in the Republic of South Africa) relating to companies (including insider dealing), building societies, insurance, banking or other financial services?
________________________
2. Have you ever been convicted of any criminal offence other than the offences listed above or been subject to penalties for tax evasion?
3. Have you at any time been declared insolvent or had your estate sequestrated?
4. Are you currently the subject of insolvency proceedings or proceedings for the sequestration of your estate or proceedings for the recovery of money?
5. Are you aware of any such proceedings?
6. Have you at any time entered into a composition or arrangement with creditors, or failed to satisfy a judgement debt under a court order within one year of the making of the order?
7. Have you ever been a member of any other exchange either in the Republic of South Africa or internationally?
8. If your answer to question 7 is yes, are you currently a member of such an exchange?
9. Have you at any time been refused or had your membership revoked of any association of dealers in financial instruments or any stock exchange?
10. Have you at any time been refused or had your membership revoked by any body or organisation recognised or designated under the Financial Markets Act No 19, the Financial Sector Regulation Act, 2017 or by any other body in relation to your business or professional activities?
11. Are you currently undergoing any investigation or disciplinary or arbitration procedure in your personal capacity in relation to any association of dealers in financial instruments or any stock exchange?
12. Have you ever been refused entry to any profession or vocation or been dismissed from any office or position of trust, whether or not remunerated?
13. Have you at any time been refused the right or been restricted in the right to carry on any trade, business or profession for which a specific licence, registration or other authority is required?
14. Have you ever knowingly been the subject of an official investigation into allegations of misconduct or malpractice in connection with investment business?
15. Have you, in connection with the formulation of management of any company, partnership or incorporated association, been held by a court to be civilly liable for any fraud, theft, wrongful trading or other misconduct towards such a body or towards any members or creditors of such a body?
16. Have you ever been the subject of any civil action which has resulted in a finding against you by a court in respect of investment business conduct, or, in respect of any matter other than the conduct of investment business involving a liability?
17. Have you ever been concerned with the management or conduct of affairs of any company which has been at any time during your involvement investigated by an inspector appointed under the Companies Act, 2008 or other securities legislation, or required to produce books and papers to the Companies and Intellectual Property Commission (CIPC) other than in regular inspections required by the Registrar?
18. Are you presently associated with any company, close corporation or subsidiary thereof to a significant extent? If so, please identify the company and the nature of its operations.
19. Is there any further information to be disclosed material to your application for membership or registration as an officer that may influence the JSE’s decision and/or may have a bearing on such application? If so, please submit details on a separate sheet.
I, ________________________ hereby confirm that I hold a relevant qualification and comply with the fit and proper criteria, as set out in JSE [select option below]
I further:
1. authorise the chief executive officer of the JSE Limited (“JSE”) or her designate to obtain additional information, whether from me or another party, as is deemed necessary in respect of my application;
2. state that the information provided by me herein is true and correct and that I am aware that any false declaration or statement shall be deemed to be a contravention of the JSE rules and may result in an automatic refusal by the JSE to register me as an officer of the member or if such information becomes known following my registration, may result in my registration as an officer being summarily cancelled;
3. agree to be bound by the provisions of the Financial Markets Act No 19 of 2012, as amended and the rules and directives of the JSE; and
4. undertake to immediately inform the compliance officer of my member and the chief executive officer of the JSE or her designate of any changes to the, information contained in this declaration that occur during my tenure as a registered officer.
Signed: _________________________ Date: _________________________ (Applicant Officer)
I, ________________________________ hereby declare that the information contained herein is to the best of my knowledge both true and correct and I undertake to inform the JSE immediately in writing of any changes to the information as communicated to me by the registered officer. I acknowledge that the information supplied by way of this form will be retained by the JSE and used for regulatory purposes and I consent to the use of the information for this purpose. I accept that the cut-off time for the submission of this form by email is 15h00 and provided that all necessary information has been provided and all qualifying criteria have been met, the JSE will begin the approval process in respect of the Applicant Officer.
Signed: _________________________ Date: _________________________ (Compliance Officer)
I, ________________________________ hereby declare that the information contained herein is to the best of my knowledge both true and correct and I undertake to inform the JSE immediately in writing of any changes to the information as communicated to me by the registered officer. I acknowledge that the information supplied by way of this form will be retained by the JSE and used for regulatory purposes and I consent to the use of the information for this purpose.
