Instruction CPO/B-2000/1 on Applications for Bank License

INSTRUCTION CPO/B-2000/1
ON APPLICATIONS FOR BANK LICENSE
I. AUTHORITY
In carrying out its responsibility for issuing licenses to banks and to branches of foreign banks pursuant to Sections 2.4 and 3 of UNTAET Regulation No. 2000/8 on Bank Licensing and Supervision, the Central Payments Office of East Timor, hereinafter “CPO”, provides this instruction on applications for bank license.
II. LICENSES TO PERFORM FINANCIAL ACTIVITIES
In accordance with UNTAET Regulation No. 2000/8 on Bank Licensing and Supervision, Section 24, there are three classifications of bank licenses which the CPO designates A, B, and C, as follows:
License
Level
Authorized Financial
Activities per Regulation
Capital Requirement
(Section 24.1)
Amount of Capital in U.S. dollar
(Section 4.1)
A 24.2, 24.3, 24.4 3 x Minimum $6,000,000 B 24.2, 24.3 2 x Minimum $4,000,000 C 24.2 Minimum $2,000,000
III. FORM OF APPLICATION
The initial application for a license and subsequent application for a higher license must be in writing and in English. The original application and two complete copies and the application fee shall be submitted to the CPO. In the case of a proposed new bank, the application must be signed by the bank’s founders. In the case of a branch of an existing foreign bank, the application must be signed by an authorized officer of the foreign parent bank. Any subsequent application(s) must be signed by the appropriate designated bank authority
IV. DESIGNATION OF SPOKESPERSON
Applicants should authorize in writing an English-speaking spokesperson to act on their behalf regarding the application. All communications from the CPO related to the bank license application will be directed to this designated spokesperson. The spokesperson’s name, address and telephone number should be provided in the application. If, during the time the application is pending with the CPO, the name, address, or telephone number of the spokesperson changes, the CPO should be notified in writing immediately.

V. DEFINITIONS
Administrator means any person who is an officer of a bank including any member of the Governing Board or the Audit Committee and further including any person who alone or together with one or more others has the authority to enter into commitments for the account of the bank. Affiliate of a bank means (1) a subsidiary; (2) a company of which the bank is a subsidiary; or (3) a company that is under common control with the bank. Home Country Supervisor means —the competent authority that supervises the activities of the banks in the country in which the head office of the foreign bank is located. Person means —an individual or a juridical person including a company, partnership, association, and any group of persons acting together with a common purpose, whether or not organized as a formal business entity. Principal shareholder means —a person that owns directly or indirectly ten percent or more of any class of shares with voting rights of a bank. Related person —includes without limitation: (1) any administrator of the bank; (2) any principal shareholder of the bank; (3) any person who is related to such administrator or principal shareholder by marriage, consanguinity to the second degree, or business interest; and (4) any legal person that has a significant interest in a juridical person in which the bank has a significant interest.
VI. INFORMATION REQUIRED FOR BANK LICENSE APPLICATIONS
Pursuant to Sections 5.1–5.4, and 7.2 of UNTAET Regulation No. 2000/8 on Bank Licensing and Supervision, the CPO requires that bank license applications contain the following information. In accordance with Section 5.3, the CPO has the right to request any additional or supplementary information if, in the opinion of the CPO, the basic information is incomplete or is insufficient to make a decision on the license application. A. New Banks Regulation on Bank Licensing and Supervision, Sections 5.1-5.3

1. Minutes of the meeting of the founding shareholders authorizing the
   establishment of the bank.
2. Information on the establishment of the bank:
   a. the name and type of bank.

b. the types and number of shares
c. the amount of the actual or proposed paid-in capital of the bank and the
amount that may have previously been paid in or subscribed to; provided, no capital for proposed banks shall be contributed in-kind
3. The charter and by-laws of the bank approved by the meeting of the founding
shareholders, which shall be in accordance with the requirements of Section 15 of UNTAET Regulation No. 2000/8 on Bank Licensing and Supervision.
4. For each person who proposes to hold an equity interest in the new bank:
a. for individual and juridical persons who will not be principal shareholders in the bank:
Χ name, address;
Χ declared ownership interest in the capital of the bank: number and type of shares to be subscribed, purchase price per share, total purchase price, and resulting percentage ownership in the bank; Χ membership in companies, partnerships, associations, and groups of persons acting together with a common purpose, whether or not organized as a formal business entity; Χ for individuals:
country identification number or passport number and data; current employment and position held; Χ for juridical persons:
disclose persons owning ten percent or more of the shares, or who are otherwise in control of the juridical person. b. For individual and juridical persons who are proposed to be principal shareholders in the bank:
Χ information listed in section (a) above; Χ business and/or professional activity for the past ten years; Χ information as to whether the proposed principal shareholder is, or has ever been, a principal shareholder or administrator in any bank located anywhere in the world; Χ signed financial statements for the past three years, either audited if available or in the format prescribed by the CPO; and Χ the source of the funds to be used to purchase shares in the bank. If assets are to be sold or funds are to be borrowed, provide full information.
5. For each person proposed to be an administrator of the:

At a minimum, information must be submitted on all proposed members of the Governing Board and the Audit Committee, the President, Vice-President(s), Chief Accountant, Chief Lending Officer, and Treasury Officer or their equivalents. Any relevant information that necessary to determine the qualifications, experience and integrity of those persons shall be disclosed. Χ name, residential address; Χ country identification number or passport number and data; Χ business and/or professional activity for the past ten years, included in a detailed curriculum vitae; Χ information as to whether the proposed administrator is, or has ever been, a principal shareholder or administrator in any bank located anywhere in the world; and Χ membership in companies, partnerships, associations, and groups of persons acting together with a common purpose, whether or not organized as a formal business entity.
6. Copies of any proposed employment contracts.
7. List of the proposed membership, terms, and remuneration of the Governing
Board.
8. List of proposed membership of the Audit Committee and Risk Management
Committee. In accordance with Section 19.5 of UNTAET Regulation No. 2000/8 on Bank Licensing and Supervision, in lieu of a Risk Management Committee, a bank may have a separate Credit Committee and Asset and Liability Management Committee.
9. A list of all related persons and affiliates of the proposed bank.
10. A business plan and projected financial statements for the first three years of the
bank’s operation. The business plan should include both a narrative section in which the items below are discussed, and pro forma financial statements using the format provided by the CPO. Assumptions - Discuss all assumptions used in the preparation of the business plan such as general economic conditions in East Timor, level of competition, growth forecasts, interest rates on earning assets such as loans and investments and applicable liabilities including deposits and borrowed funds. Organizational Structure - Describe the structure of the organization and administration of the bank; address the Board of Governors, permanent committees, administrators, operational and administrative divisions within the bank and their sub-divisions and functions, supervisory positions, lines of authority and reporting relationships, and staffing projections.

Financial Activities - Discuss the types and scale of financial activities envisaged, based on the financial activities authorized by the license level applied for (Section 24 of UNTAET Regulation No. 2000/8 on Bank Licensing and Supervision). This presentation should be supported by information which clearly shows the capability to undertake those activities in terms of management, expertise, systems support, organization and staff. Specifically address: (1) the types of loans to be offered, targeted economic sectors, and plans for diversification; (2) planned deposit and borrowing activities; (3) method for pricing loans and deposits; and (4) proposed off-balance sheet activities. Financial Projections - Provide support for the business plan’s financial projections for asset and liability growth, profitability, maintenance of adequate regulatory capital as prescribed by the CPO, and dividends. Risk Management - Describe the bank’s risk management processes: risk identification, measurement, monitoring and control. Address the bank’s plans for controlling the following risks: (1) asset and liability management including liquidity, interest rate, and maturity risk; (2) credit risk; (3) operational risk; (4) market risk; and (5) all other risks to which the bank will be exposed when engaged in the financial activities envisaged by the business plan. With regard to credit risk, specifically address: (1) credit policies including loans to shareholders, administrators, related persons and affiliates; (2) plans to minimize concentration risk through diversification and limitations on credit exposures both to individual borrowers and to groups of related borrowers; and (3) asset quality considerations such as underwriting, loan classification system, and provisioning for loan losses. Operations Systems - Describe the bank’s operations systems, including accounting, record keeping, reporting including to the management, Board of Governors, shareholders and the CPO, risk measurement and controls, and internal audit and controls. Provide evidence that, from the commencement of operations, the bank’s systems will be established and will be capable of producing all required regulatory and prudential reports in an accurate and timely fashion. Other - Discuss the bank’s premises and indicate whether facilities and equipment will be leased or purchased. Address any plans for future expansion, including future plans for branch offices. Discuss plans for any transactions with related persons and affiliates. Confirm the use of International Accounting Standards, and indicate plans to engage an independent, external auditor in accordance with Section 32 of UNTAET Regulation No. 2000/8 on Bank Licensing and Supervision.

Pro Forma Financial Statements - Based upon the preceding narrative section, submit a pro forma balance sheet and income statement and any necessary supporting schedules for each of the first three years of the bank’s operation. Business Plan Monitoring – Discuss the methods that the Governing Board will use to regularly monitor the bank’s performance under the business plan and bank management’s adherence to the plan. B. Branches of Foreign Banks Regulation on Bank Licensing and Supervision, Section 5.4

1. A certified copy of the minutes of the meeting of the Governing Board of the
   foreign bank wherein the bank license application was approved and an officer was authorized to sign and submit the application to the CPO.

2. An official letter addressed to the CPO and received directly from the home
   country supervisor, which affirms the following:
   a. The applicant foreign bank is authorized to engage in the business of receiving money deposits or other repayable funds in the foreign country where its head office is located; b. The applicant foreign bank is a bank “in good standing” with the home country supervisor, that is, the bank is fully meeting all capital requirements and has no formal enforcement actions currently outstanding or pending;
   c. The home country supervisor has given written consent for the applicant
   foreign bank to operate a branch office in East Timor subject to the CPO’s approval of the said license application; d. The applicant foreign bank including its branches in East Timor is, and will be, supervised on a consolidated basis by the home country supervisor, in accordance with the principles contained in the Basle Concordat; and e. The home country supervisor agrees to keep the CPO informed of any significant developments adversely affecting the parent bank’s financial soundness and/or reputation globally.

3. The following information on all administrators of the applicant foreign bank and
   on persons proposed to be administrators of the branch in East Timor shall be submitted. At a minimum, information must be submitted on members of the Governing Board and Audit Committee, the President, Vice-Presidents, Chief

Accountant, Chief Lending Officer, Treasury Officer, and Chief of the Branch or their equivalents. The information shall be adequate to permit evaluation of the administrators’ of the bank and to assess the qualification, experience and integrity of the chief of the branch. Χ name, residential address; Χ country identification number or passport number and data; Χ business and/or professional activity for the past ten years; provided however, that the proposed administrators of the branch shall submit a detailed curriculum vitae; Χ information as to whether the administrator or proposed administrator is, or has ever been, a principal shareholder or administrator in any other bank located anywhere in the world; and Χ membership in companies, partnerships, associations, and groups of persons acting together with a common purpose, whether or not organized as a formal business entity.
4. For each person who is a principal shareholder of the applicant foreign bank:
Χ name and address;
Χ for individuals - country identification number or passport number and data; Χ ownership interest in the capital of the bank: number of shares owned and/or controlled, and the corresponding percentage ownership in the bank; Χ business and/or professional activity for the past ten years; Χ for juridical persons - disclose persons owning ten percent or more of the stock, or who are otherwise in control of the juridical person; Χ membership in companies, partnerships, associations, and groups of persons acting together with a common purpose, whether or not organized as a formal business entity; Χ information as to whether the principal shareholder is, or has ever been, a principal shareholder or administrator in any other bank located anywhere in the world; and Χ financial statements for the past three years, either audited if available or in the format prescribed by the CPO.
5. Copies of any proposed employment contracts with persons proposed to be
administrators of the branch.
6. A copy of the most recent “full-scope” examination report or such extracts thereof
as may be agreed between the CPO and the Home Country Supervisor of the applicant foreign bank .
7. The following financial information on the applicant foreign bank.

Χ financial statements including reports on regulatory capital submitted to the home country supervisor for the past three years; Χ annual reports for the past three years; and Χ most recent audit report including management letter or such extracts thereof as may be considered relevant by the CPO.
8. A list of all related persons and affiliates of the applicant foreign bank including
those of the proposed branch in East Timor.
9. A business plan and projected financial statements for the first three years of the
bank’s operation. The business plan should include both a narrative section in which the items below are discussed, and pro forma financial statements using the format provided by the CPO. Assumptions - Discuss all assumptions used in the preparation of the business plan such as general economic conditions in East Timor, level of competition, growth forecasts, interest rates on earning assets such as loans and investments and applicable liabilities including deposits, borrowed funds. Organizational Structure - Describe the structure of the organization and administration of the branch; address any in-country oversight boards and/or permanent committees, administrators and other supervisory positions, operational and administrative divisions within the branch and their functions, lines of authority and reporting relationships, and staff projections. Provide a copy of the current organization chart of the parent foreign bank. Show the lines of authority and reporting from the branch in East Timor to the parent foreign bank. Financial Activities - Discuss the types and scale of financial activities envisaged for the branch, based on the financial activities authorized by the license level applied for. This presentation should be supported by information which clearly shows the capability to undertake those activities in terms of management, expertise, systems support, organization and staff. Specifically address: (1) the types of loans to be offered, targeted economic sectors, and plans for diversification; (2) planned deposit and borrowing activity; (3) method for pricing loans and deposits; and (4) proposed off-balance sheet activities. Financial Projections - Provide support for the business plan’s financial projections for asset and liability growth and profitability. Risk Management - Describe the bank’s risk management processes: risk identification, measurement, monitoring and control. Address the parent bank’s plans for controlling the following risks both on a consolidated basis at the parent bank level and specifically at the branch in East Timor: (1) liquidity, interest rate, and maturity risk (asset and liability management); (2) credit risk; (3) operational

risk; (4) market risk; and (5) all other risks to which the bank will be exposed by operating a branch in East Timor which is engaged in the financial activities proposed. With regard to credit risk, specifically address: (1) credit policies including loans to shareholders, administrators, related persons and affiliates); (2) plans to minimize concentration risk through diversification and limitations on credit exposures both to individual borrowers and to groups of related borrowers; and (3) asset quality considerations such as underwriting, loan classification system, and provisioning for loan losses. Operations Systems - Describe the bank’s operations systems, including accounting, record keeping, reporting (including to the management, Board of Governors, shareholders and the CPO), risk measurement and controls, and internal audit and controls. Indicate whether the branch in East Timor will have operations systems independent of the parent bank and, if so, how accounts and other information will be consolidated for reporting purposes. Provide evidence that, from the commencement of operations, the systems at the branch will be established and capable of producing all required regulatory and prudential reports in an accurate and timely fashion, both on an individual and a consolidated basis. Other - Discuss the branch premises and indicate whether facilities and equipment will be leased or purchased. Address any plans for future expansion, including future plans for branch offices. Indicate the amount of capital with which the branch’s activities in East Timor will be funded or the guarantee offered to support the level of license requested by the bank. Discuss plans for any transactions with related persons and affiliates. Confirm the use of International Accounting Standards, and indicate plans to engage an independent, external auditor in accordance with Section 32 of UNTAET Regulation No. 2000/8 on Bank Licensing and Supervision. Pro Forma Financial Statements - Based upon the preceding narrative section, submit a pro forma balance sheet and income statement and any necessary supporting schedules for each of the first three years of the bank’s operation. Business Plan Monitoring - Discuss the methods that the parent foreign bank’s Governing Board will use to regularly monitor the performance of the branch under the business plan and branch management's adherence to the plan.
C. Increase License Levels of Existing Banks to Engage in Additional Activities

Regulation on Bank Licensing and Supervision, Section 7.2

1. A certified copy of the minutes of the meeting of the Governing Board of the
   bank wherein the bank license application was approved.
2. Information which confirms that the bank has, and will maintain, twice the
   minimum required amount of regulatory capital for a Level B license, and three times the minimum required amount of regulatory capital for a Level A license.
3. Appropriate changes to the bank’s charter and by-laws, revised to reflect the new
   license level, and approval by the Governing Board.
4. A summary of the new financial activities authorized by the higher license level
   in which the bank plans to engage. This summary should be supported by information which clearly shows the capabilities for those activities in terms of expertise, systems support including that policies, procedures, and internal controls will be in place prior to engaging in new activities, management, staff, and organization.
5. If a bank is in its first three years of operation, a revised business plan must be
   submitted to show the impact that the higher license level and new financial activities will have on the operations of the bank. 26 October 2000 Fernando De Peralto, General Manager C:\My Documents\application bank license.doc

PRO-FORMA FINANCIAL STATEMENTS AND DOCUMENTS INSTRUCTION ON APPLICATIONS FOR BANK LICENSE Business Plan pro forma Balance Sheet (in 000's US$) Year 1 Year 2 Year 3 ASSETS

1. Cash
2. Due from banks
3. Due from BPA
4. Interbank placements
5. Total Securities
   (5a + 5b)
   5a. Securities held for sale
   5b. Securities held for investment
6. Net loans and finance lease
   receivables
   [(6a + 6b) - 6c]
   6a. Total loans
   6b. Total finance lease receivables
   6c. Allowance for loan and lease loss
7. Fixed Assets, net
8. Accrued interest receivable
9. Other real estate owned
10. Other assets
11. TOTAL ASSETS
    (Sum of Lines 1 through 10)

INSTRUCTION ON APPLICATIONS FOR BANK LICENSE Business Plan Pro forma Balance Sheet, page 2 Year 1 Year 2 Year 3 LIABILITIES
12. Total Deposits
(13 + 14)
13. Total non-interest bearing
deposits
(13a + 13b + 13c)
13a. Due to banks
13b. Individual deposits
13c. Deposits of juridical persons
14. Total interest bearing deposits
(14a + 14b + 14c)
14a. Due to banks
14b. Individual deposits
14c. Deposits of juridical persons
15. Total borrowings
(15a + 15b)
15a. Short-term borrowings
15b. Long-term borrowings
16. Accrued interest payable
17. Other liabilities
18. TOTAL LIABILITIES
(12 + 15 + 16 + 17)
STOCKHOLDERS' EQUITY
19. Common stock
20. Preferred stock
21. Surplus
22. Retained earnings
23. TOTAL STOCKHOLDERS' EQUITY
(Sum of Lines 19 through 22)
24. TOTAL LIABILITIES AND
STOCKHOLDERS' EQUITY(18 + 23)

INSTRUCTION ON APPLICATIONS FOR BANK LICENSE Business Plan pro forma Income Statement (in 000's US$) Year 1 Year 2 Year 3

1. Total Interest Income
   (1a + 1b + 1c + 1d + 1e +
   1f)
   1a. Interest on due from banks
   1b. Interest on interbank placement
   1c. Interest and dividends on securities for sale 1d. Interest and dividends on securities held for investment 1e. Interest, discount and fees on loans 1f. Other interest income
2. Total Interest Expense
   (2a + 2b + 2c + 2d + 2e)
   2a. Interest on due to banks
   2b. Interest on individual deposits
   2c. Interest on deposits of juridical persons 2d. Interest on short￾term borrowings 2e. Interest on long-term borrowings
3. Net Interest Income (1 - 2)
4. Allowance for loan and
   lease loss
5. Net interest income
   after allowance for loan and lease loss
   (3 - 4)

INSTRUCTION ON APPLICATIONS FOR BANK LICENSE Business Plan pro forma Income Statement, page 2 Year 1 Year 2 Year 3
6. Total non-interest income
(6a + 6b + 6c + 6d + 6e)
6a. Realized gains (losses) on securities available for sale 6b. Realized gains (losses) on securities held for investment 6c. Foreign exchange gains (losses) 6d. Commission income 6e. Other non-interest income
7. Total non-interest expense
(7a + 7b + 7c + 7d + 7e + 7f)
7a. Salaries and wages
7b. Bonuses
7c. Pension, insurance and other payments 7d. Fixed Assets (net) 7e. Accounting, legal, and consulting fees 7f. Other non-interest expenses
8. Net income before extraordinary
items, taxes and dividends
[5 + ( 6 - 7)]
9. Extraordinary gains (losses)
10. Taxes
11. Dividends
12. Net Income or Loss
[8 - (9 + 10 + 11)]

INSTRUCTION ON APPLICATIONS FOR BANK LICENSE Balance Sheet for Individuals (in 000's US$) Name: ______________________________ Current date 1 year ago 2 years ago ASSETS

1. Cash
2. Marketable Securities
3. Other Securities
4. Loans Receivable
5. Real Estate
6. Proprietary Interests
7. Other Assets
8. TOTAL ASSETS
   LIABILITIES AND NET WORTH
9. Loans Payable
10. Other Liabilities
11. TOTAL LIABILITIES
12. NET WORTH
    (Total Assets minus Total
    Liabilities)
13. TOTAL LIABILITIES AND NET
    WORTH
14. Contingent Liabilities

INSTRUCTION ON APPLICATIONS FOR BANK LICENSE Income Statement for Individuals (000'S US$) Name: ______________________________ Current Year 1 year ago 2 years ago INCOME

1. Salaries, Wages,
   Commissions, Bonuses, or
   Other Income from
   Employment
2. Dividends
3. Interest
4. Royalties
5. Distributions from Estates
   and Trusts
6. Cash Received from Business
   Interests
7. Rents Received (Gross)
8. Other Income
9. TOTAL INCOME
   EXPENSES
10. Personal Expenses
    (Household, etc.)
11. Personal Expenses
    (Household, etc.)
12. Real Estate Investment
    Expenses
    (excluding loans)
13. Loans, Principal and
    Interest
14. Insurance Payments
15. Taxes
16. Other Expenses
17. TOTAL EXPENSES
18. NET INCOME / (LOSS)

INSTRUCTION ON APPLICATIONS FOR BANK LICENSE Balance Sheet for Juridical Persons (000'S US$) N me:____________________________ a Current Date 1 year ago 2 years ago ASSETS

1. Cash
2. Deposits in Banks
3. Securities and Investments
4. Current Inventory
5. Accounts Receivable
6. Fixed Assets:
   Land
   Buildings
   Total
7. Other Assets
8. TOTAL ASSETS
   LIABILITIES
9. Loans Payable
   Owed to Banks
   Owed to Others
   Total
10. Accounts Payable
11. Other Liabilities
12. TOTAL LIABILITIES
    NET WORTH
13. Capital Stock
14. Surplus
15. Retained Earnings
16. Current Period Net
    Income/(Loss)
17. TOTAL NET WORTH
18. TOTAL LIABILITIES AND NET
    WORTH
19. Contingent Liabilities

INSTRUCTION ON APPLICATIONS FOR BANK LICENSE Income Statement for Juridical Persons (000's US$) Name: ______________________________ Current Year 1 year ago 2 years ago INCOME

1. Interest and Dividends
2. Sales of Goods and
   Merchandise
3. Other Income
4. TOTAL INCOME
   EXPENSES
5. Cost of Goods and
   Merchandise
6. Wages and Employee Benefits
7. Cost of Office Occupancy
   (Including Depreciation and/or Amortization)
8. All Other Expenses
9. TOTAL EXPENSES
10. NET INCOME / (LOSS)

INSTRUCTION ON APPLICATIONS FOR BANK LICENSE Information on Proposed Administrators Name of Proposed Bank Proposed position within the bank Full name, last name first Date, month, year and place of birth Citizenship Place of residence Country identification number or passport number and data Qualifications and education (attach detailed curriculum vitae) Business and/or professional experience for the past ten years, starting with the most recent:
Name and Address of organization
Position held, ownership interest (amount, percent of total) Beginning and ending dates (month/day/year) Reason for leaving Membership in companies, partnerships, associations, and groups of persons acting together with a common purpose, whether or not organized as a formal business entity:
Name, address, and type of entity
Position held or relationship
Ownership interest (amount, percent of total) Have you ever owned or controlled 10% or more of the stock, or been an administrator, of any bank anywhere in the world? If yes, provide the following information for every instance:
Name of bank, Location
Ownership Interest, Dates
Position Held, Dates
Disclose your proposed equity interest in the bank (if any):
Number of shares
Purchase price per share
Total purchase price
Percentage ownership
Signature

INSTRUCTION ON APPLICATIONS FOR BANK LICENSE Information on Individuals and Juridical Persons who will not be Principal Shareholders or Administrators in the Bank Name of Proposed Bank Full name, last name first Date, month, year and place of birth Citizenship Place of residence Country identification number or passport number and data For individuals: current employment and position held For juridical persons: Disclose persons owning 10% or more of the stock, or who are otherwise controls of the juridical person. Name, address Number of shares, percentage of total Other control features, if applicable Proposed equity interest in the bank:
Number and type of shares
Purchase price per share
Total purchase price
Percentage ownership
Membership in companies, partnerships, associations, and groups of persons acting together with a common purpose, whether or not organized as a formal business entity:
Name, address, and type of entity
Position held or relationship
Ownership interest (amount, percent of total) Signature

INSTRUCTION ON APPLICATIONS FOR BANK LICENSE Information on Principal Shareholders Name of Proposed Bank Full name, last name first Date, month, year and place of birth Citizenship and Place of residence Country identification number or passport number and data For individuals: current employment and position held For juridical persons: Disclose persons owning 10% or more of the stock, or who are otherwise controls of the juridical person. Name, address Number of shares, percentage of total Other control features, if applicable Proposed equity interest in the bank:
Number and type of shares
Purchase price per share
Total purchase price
Percentage ownership
Source of funds to purchase stock
Business and/or professional experience for the past ten years, starting with the most recent:
Name and Address of organization
Position held, ownership interest (amount, percent of total) Beginning and ending dates (month/day/year) Reason for leaving Membership in companies, partnerships, associations, and groups of persons acting together with a common purpose, whether or not organized as a formal business entity:
Name, address, and type of entity
Position held or relationship
Ownership interest (amount, percent of total) Have you ever owned or controlled 10% or more of the stock, or been an administrator, of any bank anywhere in the world? If yes, provide the following information for every instance:
Name of bank, Location
Ownership Interest, Dates
Position Held, Dates
Attach signed financial statements for the past three years, either audited, if available, or in the format prescribed by the BPA. Signature