Nomination Form for the Position of a Board Member

Nomination Form* for the Position of a Board Member At: -------------Company

• Based on the rules of the revised Article (68) of Law No. (32) of 1968 concerning Currency, The Central
  Bank of Kuwait and the Organization of the Banking Business, Ministry of Finance’s Resolution No. (38) of 2011 with respect to Regulation of Central Bank of Kuwait’s Supervision of Finance Companies, and the Central Bank of Kuwait Board of Directors’ Resolution No. 89-B/439/2019 concerning the rules and regulations on the experience required in Article (68) of Law No. (32) of 1968 and its amendments for finance companies.

Nomination Form
For the Position of a Board Member
At ------------------------ Company
FIRST : NOMINEE’S PERSONAL INFORMATION
1- Name : ----------------------------------------------------------- 2- Date of Birth: : ----------------------------------------------------------- 3- Place of Birth : ----------------------------------------------------------- 4- Nationality : ----------------------------------------------------------- 5- Civil ID No.(If any): ----------------------------------------------------------- SECOND : ACADEMIC QUALIFICATIONS Academic Specialized Date of Name of Institution of Qualifications Qualifications Graduation Graduation 1- ------------------- ------------------- ------------------- -------------------- 2- ------------------- ------------------- ------------------- -------------------- 3- ------------------- ------------------- ------------------- -------------------- 4- ------------------- ------------------- ------------------- -------------------- “Please attach academic degrees, or official certified copies thereof” Signature of the Officer in Charge Signature of the Nominee ------------------------------------------- -----------------------------------

(2)
THIRD : BOARD MEMBERSHIP HELD BY THE NOMINEE IN WELL-KNOWN LOCAL OR FOREIGN BANKS OR FINANCIAL INSTITUTIONS, OR IN PUBLIC INSTITUTIONS OR FINANCIAL OR ECONOMICAL PUBLIC BODIES Name of the Entity Membership Period From To 1- ----------------------------------- ------------------ ------------------ 2- ----------------------------------- ------------------ ------------------ 3- ----------------------------------- ------------------ ------------------ 4- ----------------------------------- ------------------ ------------------ 5- ----------------------------------- ------------------ ------------------ “PLEASE ATTACH SUPPORTING DOCUMENTS, AND COPIES OF THE GENERAL ASSEMBLY RESOLUTIONS, OR APPROVALS ISSUED IN THIS REGARD” FOURTH: KEY JOBS AND POSITIONS HELD BY THE NOMINEE WITH GOVERNMENT BODIES OR STATE INSTITUTIONS, OR BANKING OR FINANCIAL INSTITUTIONS Name of Government Job or Period of Employment Body or Institution Position From To 1- ----------------------------------- --------------- -------------- ------------------ 2- ----------------------------------- --------------- -------------- ------------------ 3- ----------------------------------- --------------- -------------- ------------------ 4- ----------------------------------- --------------- -------------- ------------------ 5- ----------------------------------- --------------- -------------- ------------------ “PLEASE ATTACH SUPPORTING DOCUMENTS” Signature of the Officer in Charge Signature of the Nominee ------------------------------------------- -----------------------------------

(3)
FIFTH : CURRENT ACTIVITY PRACTICED BY THE NOMINEE 1- Type of activity : _ 2- Name of the institution through which you practice the activity _ 3- Period of practicing the activity _ “PLEASE ATTACH SUPPORTING DOCUMENTS” 4- Do you participate in managing another institution practicing the same activity or a competitor institution? _ __ 5- Have any institution that you managed or held a senior position therein, been previously liquidated or declared bankrupt? _ __ __ If the answer is “yes” to questions 4 and 5, please give details. -------------------------------------------------------------------------------- SIXTH : INFORMATION RELATING TO THE FINANCIAL POSITION OF THE NOMINEE 1- Have you ever abstained from paying any outstanding debt to any local or foreign banks, investment companies or any other bodies? _ __ __ If the answer is “yes”, please give details. _ __ __ 2- Have you ever entered into an amicable settlement with your creditors in Kuwait or overseas? _ __ __ If the answer is “yes”, please give details. _ __ __ 3- Have you ever been adjudicated bankrupt, whether in Kuwait or overseas? _ __ __ If the answer is “yes”, please give details and the date of issuing the court ruling. _ __ __ Signature of the Officer in Charge Signature of the Nominee ------------------------------------------- -----------------------------------

(4)
SEVENTH : OTHER INFOEMATION
1- Have you ever been convicted for a crime of immorality or dishonesty, whether in Kuwait or overseas? ------------------------------------------------------------------------------------------------ 2- Have you ever been punished by a disciplinary action by any of the former employment bodies, including service termination or removal from office, whether in Kuwait or overseas? ------------------------------------------------------------------------------------------------ If the answer is “yes” to questions 1 and 2, please give details, and the date of issuing the court ruling or the penalty resolution. ------------------------------------------------------------------------------------------------ 3- What is the percentage of your equity stake in the capital of the company for which board membership you are nominated, whether directly or indirectly? ------------------------------------------------------------------------------------------------ 4- Any other information the nominee would like to add. ------------------------------------------------------------------------------------------------ “Please attach the certificate from the Prosecution of Criminal Execution including the final rulings issued against the nominee, if any, taking into consideration that the period from the date of certificate to the date of submitting the nomination application to the Central Bank of Kuwait should not exceed one month. Any additional documents or information the nominee would like to add shall also be attached”. Declaration & Undertaking I, -------------------------, the nominee for the position of a Board Member at ------------------------- Company, do certify and attest that all data reported in this form are true and correct, and hereby declare my full responsibility therefor. I undertake to immediately notify of any amendments to the data reported under items Fifth, Sixth and Seventh from the date of submitting the form. I declare as well that I have read Article (258) of the Penal Code which reads : “If an act of forgery is committed, penalty shall be imprisonment for a period not exceeding 3 years and a fine not exceeding KD 525 or either penalty”. I am well aware that the submission of incorrect or misleading information to any authority concerned with the completion of the nomination forms, shall constitute an act of forgery as referred to in the above mentioned
article.
Signature of the Officer in Charge The Nominee: Name: ------------------- ------------------------------------------- Signature: --------------- Date: ---------------------- Declaration The undersigned declares that the data contained in this form is correct and has been reviewed and verified by the company within the limits of the available information. Name : ---------------------------------- Chairman Signature : -----------------------------