{"text_format":"1","workbook":"xlsx","n_sheets":6,"sheets":["Instructions","Glossary","I - Identification Details","II - Role","III - Background","IV - Declarations"],"not_rendered":{"charts":0,"images":1,"macros":1,"external_links":0,"defined_names":7,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Instructions","index":0,"n_rows":21,"n_cols":6,"rows_kept":21,"cut":false,"hidden":false,"merged":[[10,3,10,4],[11,3,11,4],[12,3,12,4],[0,0,0,5],[5,0,12,0],[5,1,12,1],[5,2,10,2],[11,2,12,2],[11,5,12,5],[5,3,5,4],[6,3,6,4],[7,3,7,4],[8,3,8,4],[9,3,9,4]]}
["                        Personal Questionnaire (PQ) - Instructions"]
[]
[]
[1,"This form must be completed by each intended senior executive, controller, director, and any other person or persons, by whatever name they are called, who is to have significant influence over the administration of the Entity. In case of individuals proposing to hold multiple roles within the Entity, such individuals should complete ONLY ONE form.\n\nControllers who are legal persons or legal arrangements, rather than individuals, should not complete this form. They should complete the Institutional Questionnaire instead."]
[2,"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)."]
[3,"The completed (unsigned) PQ, 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) PQ, 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 PQ 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,"Responded","Questions","Outstanding"]
[1,"Section I - Identification Details",{"$f":"'I - Identification Details'!I17","v":1},{"$f":"'I - Identification Details'!I18","v":11},{"$f":"C18/D18","v":9.0909090909090912E-2}]
[2,"Section II - Role",{"$f":"'II - Role'!G28","v":0},{"$f":"'II - Role'!G29","v":22},{"$f":"C19/D19","v":0}]
[3,"Section III - Background",{"$f":"'III - Background'!G43","v":1},{"$f":"'III - Background'!G44","v":37},2.7027027027027029E-2]
[4,"Section IV - Declarations",{"$f":"'IV - Declarations'!F12","v":0},{"$f":"'IV - Declarations'!F13","v":6},0]

{"sheet":"Glossary","index":1,"n_rows":33,"n_cols":4,"rows_kept":33,"cut":false,"hidden":false,"merged":[[32,2,32,4],[4,2,4,4],[5,2,5,4],[22,2,22,4],[23,2,23,4],[16,3,16,4],[19,3,19,4],[13,3,13,4],[14,3,14,4],[15,3,15,4],[21,2,21,4],[20,2,20,4],[0,0,0,4],[12,3,12,4],[3,2,3,4],[6,2,6,4],[9,2,9,4],[8,2,8,4],[12,1,19,1],[12,0,19,0],[17,3,17,4],[7,2,7,4],[10,2,10,4],[11,2,11,4],[18,3,18,4],[24,0,31,0],[24,1,31,1],[24,3,24,4],[25,3,25,4],[26,3,26,4],[27,3,27,4],[28,3,28,4],[29,3,29,4],[30,3,30,4],[31,3,31,4]]}
["                         Personal Questionnaire - Identification Details"]
[]
[]
[1,"Bank or Deposit Company","Means a company that licensed, or required to be licensed, under the Banks and Deposit Companies Act 1999, as a bank or deposit company."]
[2,"Close Connection or Close Links","An applicant is considered as connected with an undertaking if either the applicant in his personal capacity or any Close Relative has direct or indirect control within an undertaking. Any interest or relationship (whether financial or non-financial) would be considered as a connection/link. "]
[3,"Close Relative ","Includes spouse, domestic partner, cohabitee, child, step-child, parent, legal guardian."]
[4,"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."]
[5,"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."]
[6,"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."]
[7,"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."]
[8,"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."]
[9,"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."]
[10,"\"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."]
[11,"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."]
[12,"Politically Exposed Person","Has the meaning assigned to it in regulation 11(5) of the Proceeds of Crime (Anti-Money Laundering and Anti-Terrorist Financing) Regulations 2008."]
[13,"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."]
[14,"Trust","Means an Undertaking that 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."]
[15,"\"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."]
[16,"Use (in relation to personal information)","Has the meaning assigned to it in section 2 of the Personal Information Protection Act 2016."]

{"sheet":"I - Identification Details","index":2,"n_rows":19,"n_cols":9,"rows_kept":19,"cut":false,"hidden":false,"merged":[[14,2,14,6],[8,2,8,6],[9,2,9,6],[10,2,10,6],[11,2,11,6],[12,2,12,6],[13,2,13,6],[5,2,5,6],[6,2,6,6],[7,2,7,6],[0,0,0,6],[3,2,3,3],[3,0,4,0],[3,1,4,1],[4,2,4,3],[3,6,4,6]]}
["                         Personal Questionnaire - Identification Details",null,null,null,null,null,null,null,"Check"]
[]
[]
["I-1","Type(s) and name of Entity in relation to which the PQ is completed.","Select",null,"Select (if applicable)","Select (if applicable)",null,null,{"$f":"IF(OR(C4=0,C4=\"Select\"),0,1)","v":0}]
[null,null,"Select (if applicable)",null,"Select (if applicable)","Select (if applicable)"]
["I-2","Name and surname."," ",null,null,null,null,null,{"$f":"IF(OR(C6=0,C6=\"Enter Name and Surname\"),0,1)","v":1}]
["I-3","Any previous name(s) by which you have been known. Please also include date and reason for change. (If no change, enter \"N/A\")",null,null,null,null,null,null,{"$f":"IF(OR(C7=0,C7=\"Enter Previous Name(s)\"),0,1)","v":0}]
["I-4","Date of birth.",null,null,null,null,null,null,{"$f":"IF(OR(C8=0,C8=\"Enter Date of Birth\"),0,1)","v":0}]
["I-5","Place of birth.",null,null,null,null,null,null,{"$f":"IF(OR(C9=0,C9=\"Enter Place of Birth\"),0,1)","v":0}]
["I-6","Citizenship(s) and mode of acquisition (birth, naturalisation, passport scheme etc.).",null,null,null,null,null,null,{"$f":"IF(OR(C10=0,C10=\"Enter Citizenship and Mode of Acquisition\"),0,1)","v":0}]
["I-7","Details of passport(s)/ ID(s) held. Please also attach the relevant identification document.",null,null,null,null,null,null,{"$f":"IF(OR(C11=0,C11=\"Enter Passport Details\"),0,1)","v":0}]
["I-8","Telephone number.",null,null,null,null,null,null,{"$f":"IF(OR(C12=0,C12=\"Enter Telephone Number\"),0,1)","v":0}]
["I-9","Personal email address.",null,null,null,null,null,null,{"$f":"IF(OR(C13=0,C13=\"Enter Email Address\"),0,1)","v":0}]
["I-10","Current residential address.",null,null,null,null,null,null,{"$f":"IF(OR(C14=0,C14=\"Enter Current Residential Address\"),0,1)","v":0}]
["I-11","Previous addresses (for the past 10 years) – including start date and end date of residence. (If no other address, enter \"N/A\")",null,null,null,null,null,null,{"$f":"IF(OR(C15=0,C15=\"Enter Previous Residential Address(es)\"),0,1)","v":0}]
[]
[null,null,null,null,null,null,null,null,{"$f":"SUM(I4:I16)","v":1}]
[null,null,null,null,null,null,null,null,11]
[null,null,null,null,null,null,null,null,{"$f":"I17/I18","v":9.0909090909090912E-2}]

{"sheet":"II - Role","index":3,"n_rows":30,"n_cols":7,"rows_kept":30,"cut":false,"hidden":false,"merged":[[22,3,22,4],[2,0,2,4],[17,0,23,0],[0,0,0,4],[3,2,3,4],[5,2,5,4],[6,2,6,4],[7,2,7,4],[4,3,4,4],[8,3,8,4],[25,2,25,4],[9,0,15,0],[10,3,10,4],[11,3,11,4],[12,3,12,4],[13,3,13,4],[14,3,14,4],[15,3,15,4],[16,3,16,4],[23,3,23,4],[24,2,24,4],[17,3,17,4],[18,3,18,4],[19,3,19,4],[20,3,20,4],[21,3,21,4]]}
["                         Personal Questionnaire - Role",null,null,null,null,null,"Check"]
[]
["Note 1: (If any of the replies to Q II-7 to II-9 in this section is marked as 'Yes', please explain how the conflict will be addressed and what mitigating factors will be established to ensure that the conflict does not interfere with the necessary independence of judgement in carrying out the proposed role)"]
["II-1","Proposed position(s) with the Entity (including category of controller and indication whether other position(s) with the Entity is/are already held).",null,null,null,null,{"$f":"IF(OR(C4=0,C4=\"Enter Position and if the Position is Previously Held\"),0,1)","v":0}]
["II-2","In carrying out your duties will you be acting on the directions or instructions of any other individual or entity? If so, give full particulars.","Select",null,null,null,{"$f":"IF(OR(C5=0,C5=\"Select\"),0,1)","v":0}]
["II-3","Details of the main duties, responsibilities in relation to your proposed position(s).",null,null,null,null,{"$f":"IF(OR(C6=0,C6=\"Enter Details of Position\"),0,1)","v":0}]
["II-4","Number of staff that you will have under your management.",null,null,null,null,{"$f":"IF(OR(C7=0,C7=\"Enter Number of Staff that will be under Management\"),0,1)","v":0}]
["II-5","Number of hours per week estimated to be allocated to perform the proposed role(s).",null,null,null,null,{"$f":"IF(OR(C8=0,C8=\"Enter Number of Hours Estimated Per Week\"),0,1)","v":0}]
["II-6","Have you previously held the proposed role(s)? If so, please provide relevant details (entity, jurisdiction, start date and end date, description of duties, regulatory authority – where an authorisation was granted).","Select",null,null,null,{"$f":"IF(OR(C9=0,C9=\"Select\"),0,1)","v":0}]
["II-7","Are you a Close Relative or do you have any Close Connection or Close Links with:"]
[null,"Other members of the Entity and/or people of a senior position and/or people who are already key function holders of the Entity in connection with which this PQ is being submitted;","Select",null,null,null,{"$f":"IF(OR(C11=0,C11=\"Select\"),0,1)","v":0}]
[null,"Any of the other group entities (if applicable);","Select",null,null,null,{"$f":"IF(OR(C12=0,C12=\"Select\"),0,1)","v":0}]
[null,"Any other shareholder controllers of the Entity;","Select",null,null,null,0]
[null,"The parent undertaking or any other subsidiary entity;","Select",null,null,null,0]
[null,"Any third party service provider which services are material to the Entity;","Select",null,null,null,0]
[null,"Competitors of the Entity, the parent undertaking or its subsidiaries.","Select",null,null,null,0]
["II-8","Are you currently involved in any legal proceedings against the Entity, the parent undertaking or its subsidiaries, either directly or indirectly?","Select",null,null,null,0]
["II-9","Do you, in your private capacity, or does any Related Company or associate undertake business with the Entity? If so, give full particulars.","Select",null,null,null,0]
[null,"How many shares in the Entity (or another entity of which it is a subsidiary) are registered in your name, the name of a Related Company or associate?  If applicable, give name(s) in which shares are registered and class of shares involved.","Select",null,null,null,0]
[null,"How many shares in the Entity (or another entity of which it is a subsidiary), other than shares registered in your name or that of a Related Company or associate, are you or any Related Company or associate beneficially interested?","Select",null,null,null,0]
[null,"Do you or does any Related Company or associate hold any shares in the Entity as trustee or nominee? If so, give full particulars.","Select",null,null,null,0]
[null,"Are any of the shares mentioned in answer to the preceding three questions equitably or legally charged or pledged to any party? If so, give full particulars.","Select",null,null,null,0]
[null,"What proportion of the voting power at any general meeting of the Entity (or of another entity of which it is a subsidiary) are you or any Related Company entitled to exercise or control the exercise of?","Select",null,null,null,0]
[null,"Do you have any other relationships, positions or involvements that are not addressed in the questions above, which could adversely affect the interest of the Entity in connection with which this PQ is being submitted? ","Select",null,null,null,0]
["II-10","What undertakings (other than the Entity) are you now a director, controller or senior executive? Give relevant dates and, if you are a controller of any such undertakings, indicate the nature of that control.",null,null,null,null,{"$f":"IF(OR(C25=0,C25=\"Enter Additional Details\"),0,1)","v":0}]
["II-11","What undertakings (other than the Entity and those listed in answer to Q II-10) have you been a director, controller or senior executive of at any time during the last 10 years? Give relevant dates.",null,null,null,null,{"$f":"IF(OR(C26=0,C26=\"Enter Additional Details\"),0,1)","v":0}]
[]
[null,null,null,null,null,null,{"$f":"SUM(G4:G26)","v":0}]
[null,null,null,null,null,null,22]
[null,null,null,null,null,null,{"$f":"G28/G29","v":0}]

{"sheet":"III - Background","index":4,"n_rows":45,"n_cols":7,"rows_kept":45,"cut":false,"hidden":false,"merged":[[40,3,40,4],[3,0,3,4],[20,3,20,4],[15,3,15,4],[17,3,17,4],[16,3,16,4],[21,3,21,4],[18,3,18,4],[19,3,19,4],[9,3,9,4],[10,3,10,4],[11,3,11,4],[12,3,12,4],[25,3,25,4],[39,3,39,4],[13,3,13,4],[14,3,14,4],[8,2,8,4],[0,0,0,4],[4,2,4,4],[5,2,5,4],[6,2,6,4],[7,2,7,4],[22,3,22,4],[23,3,23,4],[24,3,24,4],[27,0,37,0],[38,2,38,4],[37,3,37,4]]}
["                         Personal Questionnaire - Background",null,null,null,null,null,"Check"]
[]
[]
["Note 2: If any of the replies to Q III-6 to III-22 and III 26 to III 27 in this section are marked as 'Yes', please provide relevant details.\nNote 3: Please note that Q III-23 to III-27 in this section are only applicable to (proposed) shareholder controllers and beneficial owners."]
["III-1","List all of your qualifications in full (a certified copy of each qualification should be attached).",null,null,null,null,{"$f":"IF(OR(C5=0,C5=\"Enter Qualifications\"),0,1)","v":0}]
["III-2","List all past and present professional memberships/associateships etc. (including start date and end date as well as the relevant professional body; indicate reason for termination of all past professional memberships).",null,null,null,null,{"$f":"IF(OR(C6=0,C6=\"Enter Professional Memberships\"),0,1)","v":0}]
["III-3","List any training/courses/seminars etc. attended relevant to the proposed role(s) (including title, duration and year attended) – if not already included in the CV.",null,null,null,null,{"$f":"IF(OR(C7=0,C7=\"Enter Training / Courses / Seminars Relevant to the Proposed Role\"),0,1)","v":0}]
["III-4","Please attach your CV (explain in this PQ any employment gaps exceeding six months).",null,null,null,null,{"$f":"IF(OR(C8=0,C8=\"Attach Curriculum Vitae\"),0,1)","v":0}]
["III-5","Any other relevant details evidencing competency for the proposed role(s). Where no prior experience relevant to the proposed role(s) exists, please provide information evidencing competency.",null,null,null,null,{"$f":"IF(OR(C9=0,C9=\"Enter Other Relevant Details\"),0,1)","v":0}]
["III-6","Have you ever, in any jurisdiction, been dismissed from any profession, vocation, office or employment, or from any position of trust or fiduciary appointment, whether or not remunerated? ","Select",null,null,null,{"$f":"IF(OR(C10=0,C10=\"Select\"),0,1)","v":0}]
["III-7","Have you ever had a registration, authorisation, membership (including an application therefor) which has been refused, revoked, withdrawn, terminated or expelled by a Regulatory Authority or government or by a professional body or association other than on a voluntary basis? ","Select",null,null,null,{"$f":"IF(OR(C11=0,C11=\"Select\"),0,1)","v":0}]
["III-8","Have you ever been barred from entry to any profession or occupation?","Select",null,null,null,0]
["III-9","Have you ever been sanctioned, censured, reprimanded, disciplined or publicly criticised by any court of law and/or tribunal, regulatory authority, public authority, officially appointed enquiry, or other professional body or trade association?","Select",null,null,null,0]
["III-10","Have you ever been subject to regulatory disciplinary measures/actions (including disqualification as a company director, discharge from a position of trust and/or public censure)?","Select",null,null,null,0]
["III-11","Have you ever had a licence or authorisation which was revoked, restricted or suspended to carry on a financial activity for which the licence or authorisation was issued?","Select",null,null,null,0]
["III-12","Have you ever been found guilty of conducting or been investigated for possible conduct of any licensable activities without the necessary licence, authorisation or permits?","Select",null,null,null,0]
["III-13","Have you (or an entity in which you hold/held a directorship position) ever been subject to an investigation (whether current or previous) or are you aware of any action that might be taken against you (or an entity in which you hold/held a directorship position) by a governmental, public authority, professional or other regulatory body or have you resigned whilst under investigation?","Select",null,null,null,0]
["III-14","Have you at any time been found in breach of regulations or convicted of any offence, criminal or otherwise, by any tribunal or court? (Including convictions under appeal, any formal notification of investigation or committal for trial).","Select",null,null,null,0]
["III-15","Have you been (or an entity in which you hold/held a directorship position) the subject of any criminal/civil investigations and/or proceedings and/or litigation?","Select",null,null,null,0]
["III-16","Have you ever held a directorship or managerial position in a regulated entity which was required to compulsorily wind up; or had an administrator, receiver or liquidator appointed; or made a compromise or similar arrangement with creditors; or ceased trading in circumstances where the creditors did not receive (or have not yet received) full settlement of their claims?","Select",null,null,null,0]
["III-17","Are there any contractual impediments or restrictions through any previous occupation or employment which preclude you in any way from taking up the proposed position?","Select",null,null,null,0]
["III-18","Are you a politically exposed person?","Select",null,null,null,0]
["III-19","Do you have any previous or pending bankruptcy, insolvency or similar proceedings? If yes, please provide relevant details.","Select",null,null,null,{"$f":"IF(OR(C23=0,C23=\"Select\"),0,1)","v":0}]
["III-20","Have you ever:\n\n- failed to satisfy any debt adjudged due and payable by you as a judgement debtor under an order of a court or tribunal?\n- received enforcement measure for any such debt?\n\nIf yes, please provide relevant details.","Select",null,null,null,{"$f":"IF(OR(C24=0,C24=\"Select\"),0,1)","v":0}]
["III-21","Have you ever been convicted of any financial crime? If yes, please provide relevant details.","Select",null,null,null,{"$f":"IF(OR(C25=0,C25=\"Select\"),0,1)","v":0}]
["III-22","Is there any additional information which you consider relevant for the consideration of your suitability or otherwise for the position(s) held/to be held? Please note that the omission of material facts may represent the provision of misleading information.","Select",null,null,null,{"$f":"IF(OR(C26=0,C26=\"Select\"),0,1)","v":0}]
["III-23","Estimate of total assets and liabilities.",null,"Enter Total Assets","Enter Total Liabilities",null,{"$f":"IF(OR(D27=0,D27=\"Enter Net Assets\"),0,1)","v":1}]
["III-24","Origin of wealth (tick as appropriate):\nNote: The Authority may require the applicant to submit supporting documentation evidencing the origin of his/her wealth"]
[null,"Employment income","Select",null,null,null,0]
[null,"Investments","Select",null,null,null,0]
[null,"Property sale","Select",null,null,null,0]
[null,"Business/company sale","Select",null,null,null,0]
[null,"Gift/inheritance","Select",null,null,null,0]
[null,"Lottery/betting/casino winnings","Select",null,null,null,0]
[null,"Mining/minting of digital assets","Select",null,null,null,0]
[null,"Trading of digital assets","Select",null,null,null,0]
[null,"Holding of digital assets (including airdrops)","Select",null,null,null,0]
[null,"Other (please specify)","Select",null,null,null,0]
["III-25","Please describe any liabilities, including contingent liabilities. In case of contingent liabilities, are you aware of any arising matters which may result in potential liabilities materialising during the next three years?",null,null,null,null,{"$f":"IF(OR(C39=0,C39=\"Enter Liability Description\"),0,1)","v":0}]
["III-26","Do the funds derive from the same sources of wealth specified above? If not, please provide relevant details.","Select",null,null,null,{"$f":"IF(OR(C40=0,C40=\"Select\"),0,1)","v":0}]
["III-27","Have you ever been asked to close a bank account or had a bank account closed by any bank? If yes, please provide relevant details. ","Select",null,null,null,{"$f":"IF(OR(C41=0,C41=\"Select\"),0,1)","v":0}]
[]
[null,null,null,null,null,null,{"$f":"SUM(G5:G41)","v":1}]
[null,null,null,null,null,null,37]
[null,null,null,null,null,null,{"$f":"G43/G44","v":2.7027027027027029E-2}]

{"sheet":"IV - Declarations","index":5,"n_rows":18,"n_cols":6,"rows_kept":18,"cut":false,"hidden":false,"merged":[[8,1,8,2],[9,1,9,2],[3,0,3,2],[0,0,0,3],[4,1,4,2],[5,1,5,2],[6,1,6,2],[7,1,7,2]]}
[" Personal Questionnaire - Declarations",null,null,null,null,"Check"]
[]
[]
["I, the applicant, hereby declare that:-"]
["IV-1","I have checked that all the questions have been completed correctly.",null,"Select",null,{"$f":"IF(OR(D5=0,D5=\"Select\"),0,1)","v":0}]
["IV-2","I have checked that any additional information has been securely attached and properly referenced in respect of any of the answers given.",null,"Select",null,0]
["IV-3","I am aware of my responsibilities arising from the legislation, rules, codes of practice, guidance notes, guidelines and any other rules or directives, which are applicable to my proposed position(s).",null,"Select",null,0]
["IV-4","The information/documentation provided is truthful, accurate and complete to the best of my knowledge and belief.",null,"Select",null,0]
["IV-5","I consent to the Use of my personal information by the BMA in accordance with its privacy policy.",null,"Select",null,0]
["IV-6","I will notify the BMA immediately if there is a material change in the information provided or in case of new facts or any other issues which may impact upon the ongoing fitness and propriety of myself or the Entity.",null,"Select",null,0]
[]
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[null,null,null,null,null,6]
[null,"Name & Surname","Email Address                                                         ",null,null,{"$f":"F12/F13","v":0}]
[]
[]
[]
[null,"Date","Signature"]