Nomination Form for Board Membership at Credit Information Company

The Central Bank of Kuwait
Supervision Sector
Nomination Form for the Board Membership at A Credit Information Company Company’s Name: …………………………………

 Based on Central Bank of Kuwait BoD’s Decision No. 90-B/439/2019 regarding the Rules and Regulations for the required Experience under Article No. (9) of the Law No. 9 of 2019 regulating the Exchange of Credit Information.

The Central Bank of Kuwait
Supervision Sector (2)
Nomination Form for the Board Membership at a Credit Information Company Company’s Name: ………………………………………………………………………………..
I. NOMINEE’S PERSONAL INFORMATION

1. Name: ……………………………………………………………....…………………..…
2. Date of Birth: ……………………………………………………….……........................
3. Place of Birth: ………………………………………………………………………..…..
4. Nationality: …………………………………………………….………………………....
5. Civil ID (if any): …………………………………………………….................................
6. Passport No. (If Civil ID is not available): ………………………………………………
   II. ACADEMIC QUALIFICATIONS
   Qualification Major Date of Graduation
   Name of Graduation
   Institution
7. ……………. ……………. ……………. …………….
8. ……………. ……………. ……………. …………….
9. ……………. ……………. ……………. …………….
10. ……………. ……………. ……………. …………….
    “University qualification or a certified copy thereof must be attached” Concerned Employee’s Approval Nominee’s Signature …………………………….. ……………………………..

The Central Bank of Kuwait
Supervision Sector (3)
Nomination Form for the Board Membership at a Credit Information Company
III. BOARD MEMBERSHIPS IN BANKS, KNOWN LOCAL OR FOREIGN FINANCIAL
INSTITUTIONS, PUBLIC INSTITUTIONS, OR FINANCIAL OR ECONOMIC PUBLIC INSTITUTIONS Name of Entity Period From To

1. …………………………………….………… ……… ………
2. …………………………………….………… ……… ………
3. …………………………………….………… ……… ………
4. …………………………………….………… ……… ………
5. …………………………………….………… ……… ………
   “Supporting documents and copies of the general assembly decisions or the related approvals must be attached”
   IV. KEY JOBS AND POSITIONS IN GOVERNMENT ENTITIES, THE STATE
   DEPARTMENTS, OR BANKING OR FINANCIAL INSTITUTIONS Name of the Government Entity or Institution Job/Position Period From To
6. ………………………… ………………………… ……… ………
7. ………………………… ………………………… ……… ………
8. ………………………… ………………………… ……… ………
9. ………………………… ………………………… ……… ………
10. ………………………… ………………………… ……… ………
    “Supporting documents must be attached”
    Concerned Employee’s Approval Nominee’s Signature …………………………….. ……………………………..

The Central Bank of Kuwait
Supervision Sector (4)
Nomination Form for the Board Membership at a Credit Information Company
V. CURRENT ACTIVITY PRACTICED BY THE NOMINEE

1. Type of Activity: …………………………………………………………………………………..
2. Name of the institution through which you practice the activity: …………………………………
3. Period of practicing the activity: ………………………………………………………………...
   “Supporting documents must be attached”
4. Do you participate in managing another institution carrying out an activity competing with or
   similar to that of the institution in which you are nominated for board membership? ……………………………………………………………………………………………..………
5. Had any institution you managed or held a senior position in been liquidated or declared
   bankrupt?
   ……………………………………………………………………………………………..………
   If “yes” for 4 and 5, please provide details.
   ……………………………………………………………………………………………..………
   VI. INFORMATION ON THE NOMINEE’S FINANCIAL POSITIONS
6. Have you ever refrained from repaying debts due to banks, investment companies or any local or
   foreign entity?
   …………………………………………………………………………………………..………
   If “yes”, please provide details.
   …………………………………………………………………………………………..………
7. Have you ever entered into an amicable settlement with your creditors in Kuwait or abroad?
   ……………………………………………………………………………………………..………
8. Have you ever been adjudicated bankrupt, whether in Kuwait or abroad?
   …………………………………………………………………………………………..………
   If “yes”, please provide details and the date of court verdict.
   …………………………………………………………………………………………..………
   Concerned Employee’s Approval Nominee’s Signature …………………………….. ……………………………..

The Central Bank of Kuwait
Supervision Sector (5)
Nomination Form for the Board Membership at a Credit Information Company
VII. OTHER INFORMATION

1. Have you ever been convicted for a crime of immorality or dishonesty, whether in Kuwait or
   overseas?
   ……………………………………………………………………………………………..………
2. Have you ever been penalized by a former employer, including service termination or dismissal,
   whether in Kuwait or overseas?
   ……………………………………………………………………………………………..………
   If “yes” for 1 and 2, please provide details and the date of issuing the ruling or penalty. ……………………………………………………………………………………………..………
3. What is your equity stake, directly or indirectly, in the company you are nominated for membership
   of its board?
   ……………………………………………………………………………………………..………
4. Any other information the nominee wants to add:
   ……………………………………………………………………………………………..………
   “A certificate from the Criminal Execution Prosecution that lists the final rulings pronounced against the nominee, if any, must be enclosed. It should be noted that the period from issuing the certificate till the date of submitting nomination application to the Central Bank of Kuwait should not exceed one month. Any other information or documents the nominee deems necessary should be also attached” Concerned Employee’s Approval Nominee’s Signature …………………………….. ……………………………..

The Central Bank of Kuwait
Supervision Sector (6)
Nomination Form for the Board Membership at a Credit Information Company Declaration & Undertaking I, ……………………., the nominee for the membership of the board of ………………. Company, hereby declare that all information provided herein is true and correct, and acknowledge my responsibility therefor. I undertake to immediately notify of any amendment to the data provided under items Fourth and Fifth from the date of submitting the form. I also declare that I have read Article (258) of the Penal Code which reads: “Whoever commits fraud shall be punished by imprisonment for a term not exceeding three years and a fine not exceeding Two Hundred and Fifty Kuwaiti Dinars or by either of these two penalties”, and I am well aware that submission of incorrect or misleading information to any authority concerned with the completion of the nomination forms, shall constitute an act of forgery. Concerned Employee’s Approval Nominee: Name: ………….……..…….. …………………………….. Signature: ………….……..…. Date: ………….……..…….. Declaration The undersigned hereby declares that the data contained in this form are correct and had been reviewed and verified by the Company within the available information. Name: …………………………………….. Chairman Signature: ………………………….……..