administration or receivership, entered into any compromise agreement, moratorium or other restructuring to avoid liquidation, administration or receivership ?* Details Are you subject to pending proceedings if any adverse finding is reached, will result in one or more of the matters set out in the paragraphs above applying to you ?* Yes No Details Passport Evidence* Copy of Passport Evidence enclosed. Please enclose copy of Passport Evidence. UAE Visa or entry stamp* Copy of UAE Visa or entry stamp enclosed. Please enclose copy of UAE Visa or entry stamp. UAE National ID* Copy of UAE National ID enclosed. Please enclose copy of UAE National ID. Evidence of Appointment* Copy of evidence of appointment enclosed. Please enclose copy of evidence of appointment. I consent to act as authorised signatory of the named partnership. I declare that the information in this application is true and complete as at the date of this form. Authorised Signatory (3) Please complete this section for each proposed authorised signatory. Use continuation sheet if necessary. Title* Forenames* Surname* Country of Residence* Nationality* Date of Birth* Business Occupation Service Address Please provide details of authorised signatory’s service address.
Have you ever been convicted of a crime involving dishonesty?* Yes No Details Have you ever served or been sentenced to a term of imprisonment?* Yes No Details Have you ever been convicted of any offence under any provision of the financial markets legislation or any offence under any provision of any foreign act governing auditors, financial markets or financial services, corporations, financial reporting, or requirements for preventing money laundering ?* Yes No Details Have you ever been banned from acting as a director of a company or other incorporated body, of from being involved in the management of any class of incorporated or unincorporated entity?* Yes No Details Have you ever been subject to disciplinary action against them by any professional body or disciplinary tribunal, where those actions resulted in penalties being imposed or censure?* Yes No
Street / Area* State / Province Emirate Country Mailing Address Please provide details of member’s mailing address. Unit Number / Level Number Building Name Street / Area / Province PO Box Number* Emirate Country Certificate Of Incorporation or Registration* Copy of Certificate Of Incorporation or Registration enclosed. Please enclose copy of Certificate Of Incorporation or Registration. Evidence of Appointment Copy of Evidence of Appointment enclosed. Please enclose copy of evidence of appointment. Resolution Authorising Incorporation of ADGM Partnership * Copy of Resolution Authorising Incorporation of ADGM Partnership enclosed. Please enclose copy of Resolution Authorising Incorporation of ADGM Partnership. I consent to act as member of the above named entity. I declare that the information in this application is true and complete as at the date of this form. Body Corporate (2) Please complete this section if member is a body corporate. Use continuation if necessary. Are you appointed as Designated Member? Yes No Company / Firm Name* Registration Number* of Registration / Incorporation* Entity Structure* Name by which the individual was formerly known for business purposes. Governing Law* Registered Office Physical Address Please provide details of member’s service address.