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BonaFide Statement
of aperson nominated as head of the internal control and internal audit department of 1) (hereinafter referred to as ‘branch office of a foreign bank‘) pursuant to the provisions of Article 7 paragraph 15 and Article 26 paragraph 6 of Act No. 483/2001Z.z. on banksand on amendments to certain laws (hereinafter referred to as ‘Banking Act‘).
Name, surname, degree:
Date of birth and/or personal number:
Nationality/citizenship:
Permanent residence address:
Position a person is nominated for:
As a nominee for the position of head of internal control and internal audit, Imake the following statement:
1.Iam not – I am2) an employee of the branch office of the above bank.
2.a)Ihave not been – have been2), in the last ten years, amember of the statutory body, authorised representative, member of the supervisory board, senior officer directly reporting to the statutory body, head of the internal control and internal audit department, or chief executive of a foreign branch, of a bank, branch office of aforeign bank, or afinancial institution whose banking licence or other licence to operate was revoked, at any time within one year before the licence was revoked; if yes, please state the position held, as well as the name and registered office of the bank, branch office, foreign bank, or financial institution concerned:
b)Ihave not been – have been2), in the last ten years, amember of the statutory body, authorised representative, member of the supervisory board, senior officer directly reporting to the statutory body, or head of the internal control and internal audit department of abank or financial institution which was placed under forced administration, at any time within one year prior to the imposition of forced administration; if yes, please state the position held, as well as the name and registered office of the bank or financial institution concerned:
c)Ich war in den letzten zehn Jahren nicht tätig - tätig2) in der Funktion eines Mitglieds des statutarischen Organs, eines Prokuristen, eines Aufsichtsratsmitglieds, eines leitenden Angestellten in der direkten Leitungstätigkeit des statutarischen Organs oder als Leiter der Abteilung Interne Kontrolle und Internes Audit in einer Bank oder einer Finanzinstitution, die in Liquidation eingetreten ist, oder, die Bankrott gegangen ist, über deren Vermögen Konkurs eröffnet wurde, der Restrukturierung bewilligt wurde, der Zwangsvergleich bestätigt oder der Vergleich genehmigt wurde, für die der Konkurseröffnungsantrag mangels Masse abgewiesen wurde, der das Konkursverfahren mangels Masse eingestellt wurde oder der der Konkurs mangels Masse aufgehoben wurde, und zwar wann immer im Zeitraum eines Jahres vor Eintreten einer solchen Situation; wenn ja, ist die ausgeübte Funktion, Name und Sitz der betreffenden Bank oder Finanzinstitution anzugeben:
d)Ihave not been – have been2), in the last ten years, given afine of more than 50% of the amount that may be imposed pursuant to Article 50, para. 2, of the Banking Act.
e)Iam not–I am2)deemed to be an untrustworthy person under the relevant regulations pertaining to the financial market.
f)Reliably, conscientiously, and without violating the generally binding legal regulations have Ibeen performing my duties or doing business in the last ten years, and I do guarantee that Iwill hold the office I am nominated for and perform the tasks arising from the relevant legal regulations, the statutes of the bank or foreign bank concerned, or from their internal rules and regulations, in a reliable manner, conscientiously, without violating the generally binding legal regulations.
3.Iam not–I am2) amember of the statutory body or the supervisory board of a legal entity (based in the Slovak Republic or abroad); if yes, please specify the position held, as well as the name and registered office of the legal entity concerned:
(At the same time, awritten document is to be presented to prove that your membership of the above bodies has been terminated, with the precise date of termination. Alternatively, abona fide statement is to be made to state that the position in question will be given up by the day of your appointment as head of internal control and internal audit.)
4.Iwill not hold, during my office as head of internal control and internal audit at the branch office in question, any office that is incompatible with the office of internal control and internal audit, according to the law of the Slovak Republic. If, at any time during my office as head of the internal control and internal audit department, anychange occurs in any of the facts that the law of the Slovak Republic establishes as a condition and/or requirement for the office of head of internal control and internal audit, or anychange in any other fact stated herein, Iwill report any such change in writing to the bank without undue delay and I will take all the available legal steps to eliminate a possible violation of the law of the Slovak Republic (e.g. by resigning from the office of head of the internal control and internal audit department).
5.Ido not have–I have2)close relatives (parent, grandparent, child, grandchild, sibling, spouse, or other persons pursuant to Article 116 of the Civil Code), who are at the present time employed by or have asimilar relationship with the bank, other bank, a branch office of aforeign bank, a foreign bank or financial institution; if yes, please enter the name, surname, and position of such closely related person, as well as the name and registered office of the bank or financial institution concerned:
6.a)Ido not have–Ihave2) anequity share or voting right in alegal entity, exceeding 5%; if yes, please state the name and registered office of the legal entity, its identification number (ICO), share capital, and the share held in percentage terms :
b)Iam not–I am2) amember of the statutory body, auditing body, or the management of alegal entity; if yes, please state the position held, name and registered office of the legal entity, its corporate identification number (ICO), share capital, and the share held in percentage terms :
7.Ihereby declare that all the data given in this statement and the documents attached is complete, true, correct, and up to date.
Date ______
Signature
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1)Please enter the full name of the branch office in line with the Companies Register.
2)Delete where inappropriate.