2024-11-12 | cba-blob-17493
Application Form for Declaration for a Dividend Payment and/or Profit Transfer
The regulatory authority requires the submission of a specific application form to declare outgoing dividend payments or profit transfers under the State Ordinance Foreign Exchange Transactions. Applicants must provide financial statements, shareholders' resolutions, and the shareholders' register to support their declaration for the specified financial years. The document mandates that the applicant truthfully fill out and sign the form without withholding any facts relevant to the foreign exchange transaction.

APPLICATION FORM FOR DECLARATION FOR A DIVIDEND PAYMENT AND/OR
PROFIT TRANSFER
(Based on the provisions, regulations, and conditions of the State Ordinance Foreign Exchange Transactions, AB 1990 No. GT 6)
- Undersigned: _______________________________________________________________
Address/Telephone/Fax: _______________________//
- Application on behalf of: ______________________________________________________
Resident/Nonresident (delete as appropriate)
Address/Telephone: /
A declaration for an outgoing dividend payment and/or outgoing profit transfer as referred to in
the Notice concerning Foreign Exchange Transactions 24/L.1, paragraph III (b) and (c), for an
amount of USD/Afl./EUR (choose as appropriate) __________
to_____________, domiciled in_____________________ :
It concerns:
Interim dividend
(Final) dividend
Profit transfer
In respect of financial year (years):(fill out financial year (years))
A copy of the following documents has to be submitted together with this application:
a. The financial statements in respect of the financial year or the financial years to which the
dividend payment(s) and/or profit transfer(s) is/are related.
b. The relevant shareholders’ resolution.
c. The shareholders’ register.
Truthfully filled out and signed without withholding any facts known by applicant and of
importance to the application.
/
Applicant’s Signature / Date (day/month/year)