Annexes to Instruction No. 19: Declaration on Honor, Attestation, and Information Sheet

ANNEX II
DECLARATION ON HONOR
I, the undersigned …………………………………, representative of the firm ……………., declare on my honor:

• that I am neither a founder, contributor in kind or in capital, nor beneficiary of special benefits, nor a member of an administrative, supervisory, or management body of the credit institution (…………………………) or any of its subsidiaries.
• that I am neither a spouse, nor a relative or ally up to the 2nd degree inclusive of the persons holding the functions mentioned above within ……………… or any of its subsidiaries;
• that I do not receive from the persons mentioned in the first paragraph, nor from …………………; or any of its subsidiaries, any remuneration or fee for any function, such as advisory or consulting services, which could impair my independence.
• that none of my partners, employees, certified public accountants, and collaborators participating in the audit mission of the credit institution (………) are in any of the aforementioned situations.

Furthermore, and in the event of the occurrence during the term of office of any of the causes of incompatibility mentioned above, I undertake to immediately terminate my functions within the credit institution (………) or, if applicable, those of the concerned collaborator, and to inform in writing within a maximum period of 15 days from the date of the incompatibility, the Board of Directors or Management Board of the credit institution as well as the Central Bank of Congo, Directorate for the Supervision of Financial Intermediaries.

Made at ……………, on
For the Firm ……………

ANNEX I
ATTESTATION
We, the undersigned Credit Institution (………) attest that:

• the choice of the Consultant …………… to carry out the mission of statutory auditor was made in respect of the incompatibility regime provided for by the legislative and regulatory provisions in force;
• neither the aforementioned statutory auditor, nor any of his partners and collaborators likely to participate in this mission, benefits from any particular privilege, nor credit conditions or deposit remuneration more favorable than those normally applied to our clientele, with our institution or any of its subsidiaries;
• The statutory auditor (………) currently holds no other function, notably of consultation or advice with our institution or any of its subsidiaries,
  …………………………………and, is bound by a consulting and advisory contract that expires on ………………….

Made at ………… on …………

For the Credit Institution ………

ANNEX III
INFORMATION SHEET
I. Identification Elements.

• Name: ………………………………………………………
• Address:…………………………………………………………………
• Legal Form: ……………………………………………………
• Date and Place of Incorporation: …………………………………...
  II. Share Capital Amount
  Name and Surname Professional Address Nationality Share of capital held
  III. Distribution of Share Capital
  NAME AND SURNAME POSITION ADDRESS