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{"sheet":"Instructions","index":0,"n_rows":23,"n_cols":6,"rows_kept":23,"cut":false,"hidden":false,"merged":[[14,3,14,4],[19,1,19,2],[20,1,20,2],[21,1,21,2],[22,1,22,2],[0,0,0,5],[7,0,14,0],[7,1,14,1],[7,2,12,2],[13,2,14,2],[13,5,14,5],[7,3,7,4],[8,3,8,4],[9,3,9,4],[10,3,10,4],[11,3,11,4],[12,3,12,4],[13,3,13,4]]}
["                         Institutional Questionnaire (IQ)- Instructions"]
[]
[]
[1,"Controllers who are individuals, rather than legal persons or legal arrangements, should not complete this form. They should complete the Personal Questionnaire instead."]
[2,"This form must be completed by the Chief Executive of the intended Institutional Controller, another person responsible for the conduct of the business of the Institutional Controller or having legal capacity to sign on behalf of the Institutional Controller. "]
[3,"In case an Undertaking is an Institutional Controller of multiple Entities, ONLY ONE form should be completed (including relevant details for all such Entities)."]
[4,"Applicants may attach files in this document (Insert Tab > Selecting Object (within the Text group) > Selecting “Display as Icon” > Selecting File Type > Selecting the appropriate file)."]
[5,"The completed (unsigned) IQ, along with all supporting documentation, should be submitted to the respective department by email at the address indicated in the adjacent table. Upon receipt of the completed (unsigned) IQ, the respective department will then email the form back to the individual identified in 'IV-Declarations' tab, for electronic signature.  \n\nWhere a document is required to be submitted in hardcopy, please forward it to either the (i) Banking, Trust, Corporate Services and Investment Department (BTCSI) or (ii) FinTech Department, Bermuda Monetary Authority, BMA House, 43 Victoria Street, Hamilton HM 12, Bermuda. Enclosures must be clearly identified.\n\nAny questions pertaining to the completion of this IQ should be addressed to the respective department by email at the address indicated in the adjacent table.","BTCSI","Bank or Deposit Company",null,"banking@bma.bm"]
[null,null,null,"Fund Administration Provider",null,"fundadmin.filings@bma.bm"]
[null,null,null,"Corporate Service Provider",null,"csp@bma.bm"]
[null,null,null,"Investment Business",null,"investmentinfo@bma.bm"]
[null,null,null,"Trust",null,"trust@bma.bm"]
[null,null,null,"Money Service Business",null,"msb.filings@bma.bm "]
[null,null,"FinTech","Digital Asset Business",null,"fintech@bma.bm "]
[null,null,null,"Digital Asset Issuer"]
[]
["COMPLETENESS CHECK"]
[]
[null,null,null,"Responded","Questions","Outstanding"]
[1,"Section I - Controller Details",null,{"$f":"'I - Controller Details'!I21","v":0},{"$f":"'I - Controller Details'!I22","v":15},{"$f":"D20/E20","v":0}]
[2,"Section II - Ownership & Control",null,{"$f":"'II - Ownership & Control'!G11","v":0},{"$f":"'II - Ownership & Control'!G12","v":7},{"$f":"D21/E21","v":0}]
[3,"Section III - Background",null,{"$f":"'III - Background'!G22","v":0},{"$f":"'III - Background'!G23","v":15},0]
[4,"Section IV - Declarations",null,{"$f":"'IV - Declarations'!F10","v":0},{"$f":"'IV - Declarations'!F11","v":4},0]

{"sheet":"Glossary","index":1,"n_rows":31,"n_cols":4,"rows_kept":31,"cut":false,"hidden":false,"merged":[[19,2,19,4],[9,2,9,4],[30,2,30,4],[20,2,20,4],[21,2,21,4],[15,3,15,4],[18,3,18,4],[0,0,0,4],[11,3,11,4],[3,2,3,4],[4,2,4,4],[7,2,7,4],[6,2,6,4],[11,1,18,1],[11,0,18,0],[16,3,16,4],[5,2,5,4],[8,2,8,4],[10,2,10,4],[17,3,17,4],[12,3,12,4],[13,3,13,4],[14,3,14,4],[22,0,29,0],[22,1,29,1],[22,3,22,4],[23,3,23,4],[24,3,24,4],[25,3,25,4],[26,3,26,4],[27,3,27,4],[28,3,28,4],[29,3,29,4]]}
["                         Institutional Questionnaire - Glossary"]
[]
[]
[1,"Bank or Deposit Company","Means a company that is licensed, or required to be licensed, under the Banks and Deposit Companies Act 1999, as a bank or deposit company."]
[2,"Corporate Service Provider","Means an Undertaking that is licensed, or required to be licensed, under the Corporate Service Provider Business Act 2012, to carry on corporate service provider business in or from within Bermuda."]
[3,"Digital Asset Business","Means an Undertaking that is licensed, or required to be licensed, under the Digital Asset Business Act 2018, to carry on digital asset business in or from within Bermuda."]
[4,"Digital Asset Issuer","Means an Undertaking that is authorised, or required to be authorised, under the Digital Asset Issuance Act 2020, to conduct a digital asset issuance in or from within Bermuda."]
[5,"Entity","Means a (i) Bank or Deposit Company, (ii) Fund Administration Provider, (iii) Corporate Service Provider, (iv) Investment Business, (v) Money Service Business, (vi) Trust, (vii) Digital Asset Business or (viii) Digital Asset Issuer."]
[6,"Fund Administration Provider","Means an Undertaking that is licensed, or required to be licensed, under the Fund Administration Provider Business Act 2019,  to carry on fund administration provider business in or from within Bermuda."]
[7,"Institutional Controller","Means an Entity's (proposed) shareholder controller, which is an Undertaking."]
[8,"Investment Business","Means a person that is licensed, or required to be licensed, under the Investment Business Act 2003,  to carry on investment business in or from within Bermuda."]
[9,"\"director\", \"controller\", “senior executive\" and \"associate\" in relation to:","Bank or Deposit Company","These terms have the meaning assigned to them in section 7 of the Banks and Deposit Companies Act 1999."]
[null,null,"Fund Administration Provider","These terms have the meaning assigned to them in section 3 of the Fund Administration Provider Business Act 2019."]
[null,null,"Corporate Service Provider","These terms have the meaning assigned to them in section 3 of the Corporate Service Provider Business Act 2012."]
[null,null,"Investment Business","These terms have the meaning assigned to them in section 7 of the Investment Business Act 2003."]
[null,null,"Trust","These terms have the meaning assigned to them in section 4 of the Trusts (Regulation of Trust Business) Act 2001."]
[null,null,"Digital Asset Business","These terms have the meaning assigned to them in section 3 of the Digital Asset Business Act 2018."]
[null,null,"Digital Asset Issuer","These terms have the meaning assigned to them in section 3 of the Digital Asset Issuance Act 2020."]
[null,null,"Money Service Business","These terms have the meaning assigned to them in section 3 of the Money Service Business Act 2016."]
[10,"Money Service Business","Means a person that is licensed, or required to be licensed, under the Money Service Business Act 2016,  to carry on money service business in or from within Bermuda  or carry on money service business as an agent for a person carrying on money service business in or from within Bermuda."]
[11,"Related Company","A “related company” in relation to an Undertaking or the parent company of such Undertaking, means a company (other than a subsidiary company) in which the Undertaking or the parent company, as the case may be, holds a qualifying capital interest.\n\nA qualifying capital interest means an interest in relevant shares of the company which the Undertaking or parent company holds on a long term basis for the purpose of securing a contribution to its own activities by the exercise of control or influence arising from that interest.\n\nA holding of 20 percent or more of the nominal value of the relevant shares of a company shall be presumed to be a qualifying capital interest unless the contrary is shown.\n\nRelevant shares means shares comprised in the equity share capital of the company of a class carrying rights to vote in all circumstances at general meetings of the company.\n\nEquity share capital means the issued share capital of a company excluding any part of that capital which, neither as respects dividends nor as respects capital, carries any right to participate beyond a specified amount in a distribution."]
[12,"Trust","Means an Undertaking that is licensed, or required to be licensed, under the Trusts (Regulation of Trust Business) Act 2001,  to carry on trust business in or from within Bermuda."]
[13,"\"Undertaking\" in relation to:","Bank or Deposit Company","Means an institution, as defined in section 2 of the Banks and Deposit Companies Act 1999."]
[null,null,"Fund Administration Provider","This term has the meaning assigned to it in section 2 of the Fund Administration Provider Business Act 2019."]
[null,null,"Corporate Service Provider","This term has the meaning assigned to it in section 2 of the Corporate Service Provider Business Act 2012."]
[null,null,"Investment Business","This term has the meaning assigned to it in section 2 of the Investment Business Act 2003."]
[null,null,"Trust","This term has the meaning assigned to it in section 2 of the Trusts (Regulation of Trust Business) Act 2001."]
[null,null,"Digital Asset Business","This term has the meaning assigned to it in section 2 of the Digital Asset Business Act 2018."]
[null,null,"Digital Asset Issuer","This term has the meaning assigned to it in section 2 of the Digital Asset Issuance Act 2020."]
[null,null,"Money Service Business","This term has the meaning assigned to it in section 2 of the Money Service Business Act 2016."]
[14,"Use (in relation to personal information)","Has the meaning assigned to it in section 2 of the Personal Information Protection Act 2016."]

{"sheet":"I - Controller Details","index":2,"n_rows":23,"n_cols":9,"rows_kept":23,"cut":false,"hidden":false,"merged":[[18,2,18,6],[12,2,12,6],[8,2,8,6],[9,2,9,6],[13,2,13,6],[14,2,14,6],[15,2,15,6],[11,2,11,6],[10,2,10,6],[0,0,0,6],[3,0,4,0],[3,1,4,1],[3,2,3,3],[17,2,17,6],[16,2,16,6],[3,6,4,6],[4,2,4,3],[5,2,5,6],[6,2,6,6],[7,2,7,6]]}
["                         Institutional Questionnaire - Controller Details",null,null,null,null,null,null,null,"Check"]
[]
[]
["I-1","Type(s) and name(s) of Entity(ies) in relation to which the IQ is completed.","Select",null,"Select (if applicable)","Select (if applicable)",null,null,{"$f":"IF(OR(C4=0,C4=\"Select\"),0,1)","v":0}]
[null,null,"Select (if applicable)",null,"Select (if applicable)","Select (if applicable)"]
["I-2","Please state the name(s) of the (prospective) Institutional Controller, including the corporate name and any business name(s) or secondary name(s) used for the purposes of or in connection with any business carried on by it.",null,null,null,null,null,null,{"$f":"IF(OR(C6=0,C6=\"Enter Name of the Prospective Institutional Controller\"),0,1)","v":0}]
["I-3","Any previous name(s) by which the Institutional Controller has been registered or has traded. Please also include date and reason for change. If no change, enter \"N/A\".",null,null,null,null,null,null,{"$f":"IF(OR(C7=0,C7=\"Enter Previous Name(s)\"),0,1)","v":0}]
["I-4","Date of incorporation/formation.",null,null,null,null,null,null,{"$f":"IF(OR(C8=0,C8=\"Enter Date of Incorporation / Formation\"),0,1)","v":0}]
["I-5","Place of incorporation/formation. Please also attach the relevant incorporation document(s).",null,null,null,null,null,null,{"$f":"IF(OR(C9=0,C9=\"Enter Place of Incorporation / Formation\"),0,1)","v":0}]
["I-6","Description of the (prospective) Institutional Controller's business.",null,null,null,null,null,null,{"$f":"IF(OR(C10=0,C10=\"Enter Description of Business\"),0,1)","v":0}]
["I-7","Registered address.",null,null,null,null,null,null,{"$f":"IF(OR(C11=0,C11=\"Enter Registered Address\"),0,1)","v":0}]
["I-8","Principal place of business (if different than the registered address. If there is no other address, enter \"N/A\").",null,null,null,null,null,null,{"$f":"IF(OR(C12=0,C12=\"Enter Principal Place of Business\"),0,1)","v":0}]
["I-9","Name of contact person.",null,null,null,null,null,null,{"$f":"IF(OR(C13=0,C13=\"Enter Contact Person Name\"),0,1)","v":0}]
["I-10","Telephone number of contact person.",null,null,null,null,null,null,{"$f":"IF(OR(C14=0,C14=\"Enter Contact Person Telephone Number\"),0,1)","v":0}]
["I-11","Email address(es) of contact person.",null,null,null,null,null,null,{"$f":"IF(OR(C15=0,C15=\"Enter Contact Person Email Address(s)\"),0,1)","v":0}]
["I-12","Institutional Controller's website(s) and social media account(s).",null,null,null,null,null,null,{"$f":"IF(OR(C16=0,C16=\"Enter Institutional Controller's Website and Social Media Account\"),0,1)","v":0}]
["I-13","Names of all directors of the Institutional Controller.",null,null,null,null,null,null,{"$f":"IF(OR(C17=0,C17=\"Enter Name of All Directors\"),0,1)","v":0}]
["I-14","Name(s) and address(es) of the Institutional Controller’s principal bankers within the last five years.",null,null,null,null,null,null,{"$f":"IF(OR(C18=0,C18=\"Enter Name and Address of Principal Bankers\"),0,1)","v":0}]
["I-15","Names of all controllers of the Institutional Controller, indicating in each case the relevant category of controller involved.",null,null,null,null,null,null,{"$f":"IF(OR(C19=0,C19=\"Enter Name of All Controllers\"),0,1)","v":0}]
[]
[null,null,null,null,null,null,null,null,{"$f":"SUM(I4:I19)","v":0}]
[null,null,null,null,null,null,null,null,15]
[null,null,null,null,null,null,null,null,{"$f":"I21/I22","v":0}]

{"sheet":"II - Ownership & Control","index":3,"n_rows":13,"n_cols":7,"rows_kept":13,"cut":false,"hidden":false,"merged":[[8,3,8,4],[4,3,4,4],[5,3,5,4],[7,2,7,4],[0,0,0,4],[6,2,6,4],[3,2,3,4],[2,2,2,4]]}
["                         Institutional Questionnaire - Ownership & Control",null,null,null,null,null,"Check"]
[]
["II-1","How many shares in the Entity(ies) are registered in the name of the Institutional Controller or a Related Company? Please provide name(s) in which the shares are registered and the class of shares involved.",null,null,null,null,{"$f":"IF(OR(C3=0,C3=\"Enter Number of Shares\"),0,1)","v":0}]
["II-2","How many shares in the Entity(ies), other than shares registered in the name of the Institutional Controller or a Related Company, is the Institutional Controller or any Related Company beneficially interested?",null,null,null,null,{"$f":"IF(OR(C4=0,C4=\"Enter Number of Shares Beneficially Interested\"),0,1)","v":0}]
["II-3","Does the Institutional Controller or any Related Company hold any shares in the Entity(ies) as trustee or nominee? If so, please provide full particulars.","Select",null,null,null,{"$f":"IF(OR(C5=0,C5=\"Select\"),0,1)","v":0}]
["II-4","Are any of the shares in the Entity(ies) mentioned in answer to questions II-1, II-2, II-3 equitably or legally charged or pledged to any party? If so, please provide full particulars.","Select",null,null,null,{"$f":"IF(OR(C6=0,C6=\"Select\"),0,1)","v":0}]
["II-5","What proportion of the voting power at any general meeting of the Entity(ies), or of another institution of which the Entity(ies) is/are subsidiary(ies), is the Institutional Controller and any Related Company entitled to exercise or control the exercise of?",null,null,null,null,{"$f":"IF(OR(C7=0,C7=\"Enter Proportion of the Voting Power\"),0,1)","v":0}]
["II-6","Name(s) of any undertaking licensed for financial services business, other than the Entity(ies) to which this form applies, of which the Institutional Controller is also a controller, indicating the percentage interest held along with the type of shares and voting rights attached to the shares held. ",null,null,null,null,{"$f":"IF(OR(C8=0,C8=\"Enter Name of Undertaking Licensed for Financial Services Business\"),0,1)","v":0}]
["II-7","Please provide audited accounts for the Institutional Controller (and, where appropriate, audited group accounts for the Controller’s group) for the last three financial years (if available).  If the most recent audited accounts are more than six months out of date, they should be accompanied by management accounts (which need not be audited) showing the current financial position and the current results of the Institutional Controller. ","Select",null,null,null,{"$f":"IF(OR(C9=0,C9=\"Select\"),0,1)","v":0}]
[]
[null,null,null,null,null,null,{"$f":"SUM(G3:G10)","v":0}]
[null,null,null,null,null,null,7]
[null,null,null,null,null,null,{"$f":"G11/G12","v":0}]

{"sheet":"III - Background","index":4,"n_rows":24,"n_cols":7,"rows_kept":24,"cut":false,"hidden":false,"merged":[[18,3,18,4],[0,0,0,4],[3,0,3,4],[19,3,19,4],[4,3,4,4],[5,3,5,4],[6,3,6,4],[8,3,8,4],[7,3,7,4],[9,3,9,4],[10,3,10,4],[11,3,11,4],[13,3,13,4],[14,3,14,4],[15,3,15,4],[16,3,16,4],[17,3,17,4]]}
["                         Institutional Questionnaire - Background",null,null,null,null,null,"Check"]
[]
[]
["Note 2: If any of the replies in this section are marked as 'Yes', please provide relevant details."]
["III-1","Does the Institutional Controller or any Related Company hold, or has it ever held, any authorisation or exemption from a supervisory or regulatory body to carry on any business in Bermuda or elsewhere?","Select",null,null,null,{"$f":"IF(OR(C5=0,C5=\"Select\"),0,1)","v":0}]
["III-2","Has any such authorisation been revoked, restricted or surrendered?","Select",null,null,null,{"$f":"IF(OR(C6=0,C6=\"Select\"),0,1)","v":0}]
["III-3","Has the Institutional Controller or any Related Company ever applied for any authorisation or exemption from a supervisory or regulatory body to carry on business in Bermuda or elsewhere other than an authorisation already mentioned in answer to question III-2?","Select",null,null,null,0]
["III-4","Has an application, referred to in question III-3, for any reason, ever been refused or withdrawn after it was made?","Select",null,null,null,0]
["III-5","Has the Institutional Controller or any Related Company ever been refused entry in Bermuda or elsewhere to any professional body or trade association concerned with financial services? ","Select",null,null,null,0]
["III-6","Is the Institutional Controller or any Related Company engaged, or does it expect to be engaged, in Bermuda or elsewhere in any litigation which may have a material effect on the resources of the Institutional Controller or the Entity?","Select",null,null,null,0]
["III-7","Is an inspector or other authorised officer of any government department or agency, professional association or other regulatory body appointed under any Bermuda law (e.g. the Companies Act 1981, the Proceeds of Crime Act 1997) or equivalent overseas enactment, investigating the affairs of the Institutional Controller or any Related Company, or has such an investigation ever previously taken place?","Select",null,null,null,0]
["III-8","Has the Institutional Controller or any Related Company been required to produce books or records pursuant to section 110 of the Companies Act 1981 or any other applicable domestic or overseas legislation? ","Select",null,null,null,0]
["III-9","Has the Institutional Controller or any Related Company within the last 10 years: "]
["(a)","Failed to satisfy a judgement debt under a court order in Bermuda or elsewhere within a year of the making of the order?","Select",null,null,null,0]
["(b)","Made any compromise or arrangement with its creditors or otherwise failed to satisfy creditors in full?","Select",null,null,null,0]
["(c)","Had a receiver appointed over any of its property in Bermuda, or has the substantial equivalent of any such person been appointed in any other jurisdiction?  If so, please provide particulars, including whether the receiver or equivalent is still acting under the appointment.","Select",null,null,null,0]
["(d)","Had a petition for an administration order or the substantial equivalent of such a petition served on it in any other jurisdiction?","Select",null,null,null,0]
["(e)","Had a notice of resolution for voluntary liquidation in Bermuda, or had the substantial equivalent of such a notice given in any other jurisdiction?","Select",null,null,null,0]
["(f)","Had a petition served in Bermuda for the compulsory liquidation of the Institutional Controller or any Related Company or had the substantial equivalent of such a petition served on it in any other jurisdiction?","Select",null,null,null,0]
["III-10","Is there any additional information which you consider relevant for the assessment of the Institutional Controller's application? \n\nNote: Please note that the omission of material facts may represent the provision of misleading information.","Select",null,null,null,0]
[]
[null,null,null,null,null,null,{"$f":"SUM(G5:G20)","v":0}]
[null,null,null,null,null,null,15]
[null,null,null,null,null,null,{"$f":"G22/G23","v":0}]

{"sheet":"IV - Declarations","index":5,"n_rows":16,"n_cols":6,"rows_kept":16,"cut":false,"hidden":false,"merged":[[7,1,7,2],[0,0,0,3],[3,0,3,1],[4,1,4,2],[5,1,5,2],[6,1,6,2]]}
["Institutional Questionnaire - Declarations",null,null,null,null,"Check"]
[]
[]
["I hereby certify that:-"]
["IV-1","The information/documentation provided is truthful, accurate and complete to the best of my knowledge and belief.",null,"Select",null,{"$f":"IF(OR(D5=0,D5=\"Select\"),0,1)","v":0}]
["IV-2","I am aware of my responsibilities arising from the legislation, rules, codes of practice, guidance notes, guidelines and any other rules or directives, which are applicable to my proposed position(s).",null,"Select",null,{"$f":"IF(OR(D6=0,D6=\"Select\"),0,1)","v":0}]
["IV-3","I consent to the Use of my personal information by the BMA in accordance with the Personal Information Protection Act 2016.",null,"Select",null,{"$f":"IF(OR(D7=0,D7=\"Select\"),0,1)","v":0}]
["IV-4","I will notify the BMA immediately if there is a material change in the information provided.",null,"Select",null,{"$f":"IF(OR(D8=0,D8=\"Select\"),0,1)","v":0}]
[]
[null,null,null,null,null,{"$f":"SUM(F5:F8)","v":0}]
[null,null,null,null,null,4]
[null,"Name & Surname","Email Address  ",null,null,{"$f":"F10/F11","v":0}]
[]
[]
[]
[null,"Date","Signature"]