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    Ownership Declaration Form

    Uploaded by

    mentora777
    This document outlines the requirements for sefa to collect beneficial ownership information under South African law. It requires identifying any individuals that own 25% or more of the client, directly or indirectly, as well as individuals with significant control over the client. The form then requests the client provide details of all such shareholders and controllers, including names, identification information, addresses and ownership percentages. It also requires supporting documentation to verify the identities and addresses of those identified.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Ownership Declaration Form

    Uploaded by

    mentora777
    179 views3 pages
    This document outlines the requirements for sefa to collect beneficial ownership information under South African law. It requires identifying any individuals that own 25% or more of the client, directly or indirectly, as well as individuals with significant control over the client. The form then requests the client provide details of all such shareholders and controllers, including names, identification information, addresses and ownership percentages. It also requires supporting documentation to verify the identities and addresses of those identified.

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    This document outlines the requirements for sefa to collect beneficial ownership information under South African law. It requires identifying any individuals that own 25% or more of the client, directly or indirectly, as well as individuals with significant control over the client. The form then requests the client provide details of all such shareholders and controllers, including names, identification information, addresses and ownership percentages. It also requires supporting documentation to verify the identities and addresses of those identified.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    179 views3 pages

    Ownership Declaration Form

    Uploaded by

    mentora777
    This document outlines the requirements for sefa to collect beneficial ownership information under South African law. It requires identifying any individuals that own 25% or more of the client, directly or indirectly, as well as individuals with significant control over the client. The form then requests the client provide details of all such shareholders and controllers, including names, identification information, addresses and ownership percentages. It also requires supporting documentation to verify the identities and addresses of those identified.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
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    SHAREHOLDING AND BENEFICIAL OWNERSHIP DECLARATION

    The Financial Intelligence Centre Act 38 2001 (FICA) requires sefa as accountable institution to
    establish who the beneficial owner of the legal person and take reasonable steps to verify the
    identity of the beneficial owners.

    Important Notes
    This form requires you to provide the name, address, ID number of the following individuals:
    1. Each individual, if any, who owns, directly or indirectly, 25% or more of the equity
    interests of the legal entity {customer} (e.g., each natural person that owns 25% or more
    of the shares of a company); and

    2. An individual with significant responsibility for managing the legal entity customer (e.g.
    Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, Managing
    Members, Partners, Trustees and Directors).

    SECTION A - CLIENT INFORMATION


    Persons acting on behalf of a legal entity must provide the following information:

    1. Name and Title of Natural Person Acting on behalf of the client:

    Title:

    Name:

    2. Name and Address of Legal Entity:

    Registration Number:

    3. Contact Number: Email Address:(if available)

    _______________________ ___________________________

    Small Enterprise Finance Agency (SoC) Ltd, Registration Number 1995/011258/06 is a Licensed Credit Provider • NCRCP 160
    Directors: Ms HN Lupuwana-Pemba (Chairperson) • Ms NA Dlamini • Ms NS Dlamini • M s C Groves Mr PM Mainganya • Mr K Molewa • Ms KK
    Moloto • Mr NA Osman • Ms H Ralinala • Mr SA Molepo (Acting Chief Executive Officer) • Ms NB Mongali (Company Secretary)
    1. SHAREHOLDERS WHO ARE NATURAL PERSON WITH 25% OR MORE SHAREHOLDING

    Name and Surname Identity/ Passport Residential Voting


    Number Address/Operating Address Rights/Shareholding
    %

    *Repeat as required

    For all shareholdings listed above, please provide:


    o Identity documents/Passport (if natural
    person)
    o Proof of residential address

    2. LEGAL ENTITIES WHO HAVE 25% OR MORE SHAREHOLDING

    Name of a Legal Company Company Registration Voting


    Entity Registration Number Address Rights/Shareholding
    %

    For all shareholdings listed above, please provide:

    o Incorporation document containing directors


    o Proof of operating address of the entity

    If the client (legal entity) has shareholders with 25% or more shareholding, please
    provide:
    o Organizational chart displaying ownership
    structures
    3. EXCHANGE LISTED LEGAL ENTITY WITH 25% SHAREHOLDING OR MORE

    If your legal entity is listed on a stock exchange

    Name of the legal entity: __________________________

    Name of the exchange: __________________________

    Company Registration Number:______________________

    % of shareholding

    * We require written confirmation of the registered name, registration number and


    physical address (verification documentation is not required)

    4. COMPLETED BY

    I, _________________________________________ (name of natural person


    authorized to sign on behalf of the client), hereby certify, to the best of my knowledge
    that the information provided above is complete and correct.

    Designation Other: __________________________________

    Contact Number: ____________________ Email Address: ________________________

    Signature: __________________ Date: 26 February 2024

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