Kinyarwanda: 1. izina ry’ikigo gifitanye isano n’ikigo cyuzurizwa iri menyekanisha (“ikigo”) ………………………………………………………………………………………………… ………………………………………………………………………………………………… 2. amazina yose: ………………………………….…………………………………………… 3. amazina gakondo na/cyangwa amazina y’idini ushobora kuba wari uzwiho mbere: ………………………………………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………. 4. vuga ububasha ufite kugira ngo ube uri kuzuza iyi nyandiko, urugero nk’uriho ubu cyangwa uzaba ugize inama y’ubutegetsi cyangwa umuyobozi mukuru cyangwa se ubikomatanyiriza hamwe cyangwa umunyamigabane ufite uruhare rugaragara. vuga inyito y’umwanya w’umurimo ukora unatange ibisobanuro bijyanye n’imirimo n’inshingano byihariye bijyanye n’uwo mwanya ukora cyangwa uzakora. niba uri kuzuza iyi nyandiko nk’ugize inama y’ubutegetsi, garagaza niba, mu mwanya wawe nk’ugize inama y’ubutegetsi, ufite inshingano cyangwa uzagira inshingano zo gucunga ubucururuzi bw’ikigo. icyiyongera kuri ibyo, tanga kopi y’umwirondoro wawe mu gihe waba utaratanzwe n’ikigo mu gusubiza ibisabwa mu mugereka wa 3a. ………………………………………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………… 5. itariki n’aho wavukiye: ………………………………………………………………………………………………… ………………………………………………………………………………………………… 6. (1) umwenegihugu wa:………………… (2) umunyagihugu wa: ……… ( igihugu) (igihugu) kuva: ………………………… kugera:……………………… (umwaka) (umwaka)
English: Personal declaration form [for individuals who are, or are proposing to become directors, managers or significant shareholders of a credit bureau] name and capacity of person making this declaration: 1. name of company in connection with which this form is being filled ……………………………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………….……. 2. full names:………………………………….……………………………………………………………………………………………………… 3. former surname(s) and /or forenames by which you may have been known: ……………………………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………. 4. please state the capacity under which you are completing this form, i.e. as a current or prospective director, or manager or any combination of these. please state your full title and describe the particular duties and responsibilities attaching to the position(s) which you hold or will hold. if you are completing this form in the capacity of director, indicate whether, in your position as director, you have or will have executive responsibility for the management of the institution‘s business. in addition, please provide a copy of your curriculum vitae unless it is already provided by the institution in response to appendix 2. ……………………………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………. 5. your date and place of birth: ……………………………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………. 6. (1) citizen of:…………………              (2) resident of:…………… (country)                                                     (country) since: …………………………                   since:……………………… (year)                                                           (year) 7. addresses: (1) present business address (rwanda since……………)                                                       (outside rwanda since...……) ………………………………………………………………………………………………………………………………………………………… (2) present residential address: (rwanda since…………...…)                   (outside rwanda since………) official gazette no 06 0f 09/02/2015