Credit Rating Services Act, 2012 (Act No. 24 of 2012)Board NoticesFit and Proper Requirements for Credit Rating AgenciesAnnexuresAnnexure D |
QUESTIONNAIRE TO BE COMPLETED IN RESPECT OF AN APPLICANT
1. Details of the Entity
1.1 Entity Name:
____________________________________________________________________________________
1.2 Registration Number:
____________________________________________________________________________________
1.3 Any other name under which the business is conducted and where is it used:
____________________________________________________________________________________
1.4 Registered address, website address and email address:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
1.5 Postal address:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
1.6 Telephone and facsimile numbers of the applicant:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
1.7 Name, physical and, postal addresses and telephone numbers of the applicant's bank
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
1.8 Name, Physical and, postal addresses and telephone numbers of the applicant's auditor
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
2. Specific test to determine the financial soundness of the applicant:
If the answer to a question is 'yes' please provide details. A separate schedule may be completed and attached to this questionnaire with proper referencing.
(a) | Provide confirmation that the assets of the applicant (excluding goodwill and other intangible assets) exceed the applicant's liabilities (excluding loans validly subordinated in favour of all other creditors). |
______________________________________________________________________________
(b) Provide confirmation that the applicant maintains current assets which are at least sufficient to meet current liabilities.
______________________________________________________________________________
______________________________________________________________________________
(c) | Has the applicant been subject to any judgment debt or award which remains outstanding or has not been satisfied within a reasonable period? |
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(d) Has the applicant made arrangements or composition with creditors, filed for business rescue, filed for bankruptcy or winding-up?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(e) Has the applicant—
(i) | been found guilty by any regulatory or supervisory body, whether in the Republic of South Africa or elsewhere, on account of an act of dishonesty, negligence, incompetence or mismanagement; or |
(ii) | has its authorisation to carry on business refused, suspended or withdrawn by any such body, on account of an act of dishonesty, negligence, incompetence or mismanagement; |
______________________________________________________________________________
______________________________________________________________________________
(f) | Has the applicant had any licence granted by any regulatory or supervisory body referred to in subparagraph (e) suspended or withdrawn by such body on account of an act of dishonesty, negligence, incompetence or mismanagement. |
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
DECLARATION
(to be completed by the chief executive officer/managing director on behalf of an applicant.)
I, the undersigned, (insert full first name(s) and surname) hereby certify that, to the best of my knowledge, the information given in the answers to the above questions are true, complete and accurate and not misleading in any respect.
I undertake that, as long as I continue to be a director of the registered credit rating agency, I will notify the registrar of any material changes to, or changes affecting the completeness or accuracy of the answers to the questions above as soon as possible, but in no event later than 21 days from the day that the change comes to my attention.
I hereby authorise the Financial Services Board, and its duly authorised verification agent, to request or confirm any information as well as any other information provided in support of this application (including but not limited to the South African Police Service, the Government of the Republic of
South Africa, industry bodies and associations, employers and any educational, training, credit bureau and fraud prevention organisations) for the purpose of verifying the information provided.
I authorise the data holders (including but not limited to the aforesaid institutions) to furnish information to the Financial Services Board and its duly appointed verification agent. I unconditionally indemnify the Financial Services Board, its verification agent and the data holders against any liability that may result from furnishing information in this regard.
Full name(s) and surname: ...........................................................................................................
Position held: ..............................................................................................................................
SIGNATURE: Chief Executive Officer / Managing Director ..............................................................
DATE .......................................................
Documents to be submitted
• signed declaration; and
• | other documents, if any, mentioned in answers to questions and in support of the information required. (Indicate the pages of each enclosure and the number of the question to which the enclosure relates and is referenced). |