TTSEC Updated Sample Compliance Officer Application Form

First Name Middle Name Surname FOR TTSEC OFFICIAL USE ONLY Country of Birth Country of Citizenship Identification No.Please provide at least two forms Other: Country: Type: Date of Birth Email Residential Address Contact Work: Home: Mobile: Fax: Highest Level Of Education (Eg. Secondary, tertiary, undergraduate etc.) Mailing Address(If different from above) Professional Qualification or Membership Have you ever had a change of name? (If yes, please give details) Are you known by any other name? (If yes please give details) Name of Employer : Category of Registration(s) employer holds with TTSEC: Annual Renewal Date of Employer's Registration with TTSEC: Position held with above registered entity:

1. Is your employer registered with another regulator? If yes please state the name of the regulator(s) and the category of registration(s) held with that regulator.

2. Does your employer have five (5) or fewer employees? If yes, please give particulars.

3. Is your employer a member of a financial group? If yes, please give particulars.

4. Have you ever been convicted of an offence in Trinidad and Tobago or elsewhere? If yes, please give particulars.

5. Are there any criminal proceedings pending against you in Trinidad and Tobago or elsewhere? If yes, please give particulars.

6. Have any civil or administrative fines or sanctions been imposed upon you? If yes, please give particulars.

7. Have you at any time failed to satisfy a judgment debt under a Court Order made in Trinidad and Tobago or anywhere else? If yes, please give particulars.

8. Have you at any time, in Trinidad and Tobago or anywhere else been declared bankrupt or are you the subject of any bankruptcy proceedings? If yes, please give particulars.

9. Are you currently a Director of any company? If yes, provide the name of the company, date and place of incorporation and the date of your appointment.

10. Have you held a senior position in a company that has gone into liquidation/ receivership within the past five (5) years? If yes, please give particulars.

11. Have you ever been a senior officer of an entity in Trinidad and Tobago or elsewhere, that was, during your period of association, convicted of an offence? If yes, please give particulars.

12. Have you been approved as a Compliance Officer by any other regulator? If yes, please give particulars

13. Have you held or do you currently hold the position of Compliance Officer in any other entity? If yes, please give particulars

14. Have you ever been disqualified or restricted in Trinidad and Tobago or elsewhere by a court from acting as a director of a company? If yes, please give particulars.

15. Have you ever been dismissed or compelled to resign from any office or employment? If yes, please give particulars.

16. Have you ever been refused entry to a professional membership/institution? If yes, please give particulars inclusive of the duration of involvement

17. Have you ever received or been exposed to any AML/CFT or compliance training? If yes, please give particulars.

18. Does your previous work experience encompass elements of compliance or risk management? If yes, please give particulars inclusive of the duration of involvement

19. Have you ever been registered in any capacity under the securities laws of Trinidad and Tobago or another jurisdiction? If yes, please give particulars inclusive of the duration of involvement

20. Has any registration identified at item 16 above been suspended, revoked, or allowed to expire? If yes, please give particulars.

21. Do you receive performance bonuses as part of your compensation package? If yes, please give particulars.

22. Does your job involve responsibility for any other functional areas in your company? If yes, please give particulars.

23. As Compliance Officer, will you be reporting directly to the Board of Directors of your employer? If not, please give particulars.

24. Is there any other information that you consider relevant to this application? If yes, please give particular.