Date of Birth* Business Occupation Service Address Please provide details of authorised signatory’s service address. Unit Number / Level Number Building Name Street / Area State / Province PO Box Number* Emirate Country* This is required to ADGM Registration Authority to assess whether you are fit and proper for the purpose of your firm’s Fit & Proper registration as a legal entity subject to ADGM Limited Liability Partnership and Commercial Licensing Regulations 2015. Have you ever been Yes convicted of a crime No involving dishonesty?* Details Have you ever served Yes or been sentenced to a term of No imprisonment?* Details Have you ever been convicted of any offence under any provision of the financial markets legislation or any offence under any Yes provision of any foreign act governing auditors, No financial markets or financial services, corporations, financial reporting, or requirements for preventing money laundering ?* Details
Date of Birth* Business Occupation Service Address Please provide details of authorised signatory’s service address. Unit Number / Level Number Building Name Street / Area State / Province PO Box Number* Emirate Country* Fit & Proper This is required to ADGM Registration Authority to assess whether you are fit and proper for the purpose of your firm’s registration as a legal entity subject to ADGM Limited Liability Partnership and Commercial Licensing Regulations 2015. Have you ever been convicted of a crime involving dishonesty?* Yes No Details Have you ever served or been sentenced to a term of imprisonment?* Yes No Details Have you ever been convicted of any offence under any provision of the financial markets legislation or any offence under any provision of any foreign act governing auditors, financial markets or financial services, corporations, financial reporting, or requirements for preventing money laundering ?* Yes No Details
p-inc-02_applicationtoregisterpartnership_2015-11-20_v10.docx