Financial Institutions Registration Form Annexed to Circular 182/2015 of May 13

Financial Institutions Registration Form Template To the Bank of Cape Verde Department of Financial Institution Supervision Plateau – Praia Subject: Registration of Financial Institutions

(Name of the Financial Institution), hereby, pursuant to Articles 21 and 22 of the Law on Financial Activities and Institutions (LAIF), approved by Law No. 62/VIII/2014 of April 23, requests its registration with the Bank of Cape Verde and, for this purpose, submits the following constituent elements:

I. Financial Institutions with headquarters in Cape Verde:

1. Name:

2. Abbreviation/Initials:

3. Object/Purpose:

4. Interbank Code:

5. Tax Identification Number (NIF):

6. Headquarters Address:

7. Postal Code:

8. Telephone:

9. Fax:

10. Email:

11. Website:

12. Date of Incorporation:

13. Authorized by Notice No. / of the Bank of Cape Verde, Published in the Official Gazette, Second Series, No. _____, dated /.

14. Date of commencement of activities:

15. Subscribed Share Capital:

16. Paid-up Share Capital:

17. Identification of shareholders holding qualified participation (greater than 2% of share capital) and respective values:
    –
    –

18. Identification of members of the governing bodies:
    a) General Assembly Board:
    – Chairman:
    – Secretary:
    b) Board of Directors:
    – Chairman:
    – Executive Director:
    – Executive Director:
    – Executive Director:
    – Non-Executive Director:
    – Non-Executive Director:
    c) Supervisory Board:
    – Chairman:
    – Member:
    – Member:

19. Attorneys-in-fact with management powers:
    –
    –
    –

20. Audit Firm or External Auditor:

21. Delegation of Management Powers:

22. Establishment of:
    a) Branch __; Location ____________________; Date of establishment //; b) Subsidiary __; Location _________________; Date of establishment //; c) Agency __; Location _______________________; Date of establishment _____.

23. Shareholder agreements regarding the exercise of voting rights:

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II. Financial Institutions authorized abroad with a branch or representation office in Cape Verde:
24. Headquarters abroad:
25. Nationality:
26. Estimated date of establishment in Cape Verde:
27. Operations the institution may conduct in its home country:
28. Operations the institution intends to conduct in Cape Verde:
29. Capital allocated to operations conducted in Cape Verde:
30. Location of branches and/or representation offices in Cape Verde:
31. Identification of managers of the branches and/or representation offices:
–
–
–

III. In order to substantiate the registration process of the requesting financial institution, the following documents are attached:
32. Notarial certificate of the deed of incorporation, executed on //_____;
33. Certificate from the Commercial Registry Office of _______________, confirming final registration and enrollment;
34. Copy of the Tax Identification Number (NIF);
35. Copy of the Articles of Association;
36. Copy of the document confirming paid-up share capital deposited in a Bank in Cape Verde;
37. Notarial certificate of the minutes from the General Assembly held on //_, in which the aforementioned governing body members were elected;
38. Other document confirming the above declarations:
_____________________________________________________________________ Date: // _________________________________ Signature of the responsible person