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{"sheet":"I-Instructions","index":0,"n_rows":11,"n_cols":11,"rows_kept":11,"cut":false,"hidden":false,"merged":[[10,1,10,8],[7,1,7,8],[6,1,6,8],[5,1,5,8],[0,0,0,18],[2,0,2,16],[4,1,4,8],[8,1,8,8],[9,1,9,8]]}
["Digital Asset Issuance Exemption Form"]
["INSTRUCTIONS",null,null,null,null,null,null,null,null,null,"Version 2021.1"]
["Completed exemption forms should be e-mailed to fintech@bma.bm"]
[]
[1,"Issuers of digital assets whose offer falls under any of the following exemptions: \n\n- Section 5(2) of the Digital Asset Issuance Act 2020 (the Act) (i.e. placement); or\n- Section 16(2) of the Act (i.e. offering via an accredited digital asset business or digital asset issuance authorised by another competent authority)\n\nare required to complete and submit this exemption form to the Authority prior to offering their digital assets in or from within Bermuda."]
[2,"In case of multiple digital asset issuances by the same issuer [different digital asset type(s) offered concurrently and/or multiple (predetermined) tranches of the same digital asset type(s)], the Authority wishes to highlight that issuers should complete and submit only one Exemption Form, including the relevant details thereto."]
[3,"This form must be completed by a person who is/will be responsible for the conduct of the business of the issuer or having legal capacity to sign on behalf of the issuer. "]
[4,"Persons completing this form 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,"Completed exemption forms should be e-mailed (unsigned) to fintech@bma.bm. If persons completing this form encounter difficulties with attaching documents or the total size of the documents exceeds the maximum size for an email, please contact the FinTech Department at the above email address to receive instructions on how to submit via the Authority’s secure drive."]
[6,"Upon receipt of the completed (unsigned) exemption form, the FinTech Department shall email the form back to the individuals identified in 'III-Declarations' tab, for electronic signatures.  "]
[7,"The 'IV-Declarations' tab should be signed electronically by two directors, or one director and an officer of the applicant."]

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["Digital Asset Issuance Exemption Form",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Check"]
["ISSUER DETAILS"]
[]
["Applicable exemption under the Digital Asset Issuance Act 2020 (please provide relevant details)",null,null,null,null,null,null,"Select",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(H4=0,H4=\"Select\"),0,1)","v":0}]
["Type of submission (in the event of additional or amended submission, please provide relevant details )",null,null,null,null,null,null,"Select",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(H5=0,H5=\"Select\"),0,1)","v":0}]
["Legal name",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(H6=0,H6=\"Enter Legal Company Name\"),0,1)","v":0}]
["Trade name (if different from legal name)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(H7=0,H7=\"Enter Trade Name\"),0,1)","v":0}]
["Business sector"]
["Registration number (Registrar of Companies)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(H9=0,H9=\"Enter Registration Number\"),0,1)","v":0}]
["Registration date"]
["Registered office address",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(H11=0,H11=\"Enter Registered Office Address\"),0,1)","v":0}]
["Contact person name",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(H12=0,H12=\"Enter Contact Person Name\"),0,1)","v":0}]
["Contact person telephone number",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(H13=0,H13=\"Enter Contact Person Phone Number\"),0,1)","v":0}]
["Contact person e-mail address(es)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(H14=0,H14=\"Enter Contact Person Email Address(es)\"),0,1)","v":0}]
["Website(s) and social media account(s)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(H15=0,H15=\"Enter Website and Social Media Account\"),0,1)","v":0}]
["If part of a group, details for all group entities [name; registration number; legal form; registered address; e-mail address(es) and website(s)] ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(H16=0,H16=\"For Groups, Enter Name, Registration Number, Legal Form, Registered Address, Email Address(es) and Website.\nFor Non-Groups, Confirm with N/A\"),0,1)","v":0}]
["Board of directors' details (name, address, telephone number, e-mail address)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(H17=0,H17=\"Enter Board of Director's Name, Address, Telephone Number, and Email Address\"),0,1)","v":0}]
["Promoter's details (name; address; telephone number; email address)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(H18=0,H18=\"Enter Promoter's Name, Address, Telephone Number, and Email Address\"),0,1)","v":0}]
["Contact person(s)' details (name; address; telephone number; email address; function within the issuer)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(H19=0,H19=\"Enter Contact Person's Name, Address, Telephone Number, Email Address and Function within the issuer\"),0,1)","v":0}]
["Digital asset details (type; lowest /highest price; soft cap; hard cap, etc.)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(H20=0,H20=\"Enter Type of Digital Asset, Lowest Price, Highest Price, Total Amount to be Issued, and any additional details that would assist the Authority\"),0,1)","v":0}]
["Please provide a list with the [i] main five hot and [ii] main five cold wallet addresses (to be) used by the issuer. \n\nWhere this information is not available, the issuer should state the relevant reason(s).",null,null,null,null,null,null,"Insert hot wallet address #1",null,null,null,"Insert cold wallet address #1",null,null,null,null,null,null,null,null,{"$f":"IF(OR(H21=0,H21=\"Other Contact Person's Name, Address Telephone Number and Email Address(es)\"),0,1)","v":1}]
[null,null,null,null,null,null,null,"Insert hot wallet address #2",null,null,null,"Insert cold wallet address #2",null,null,null,null,null,null,null,null,1]
[null,null,null,null,null,null,null,"Insert hot wallet address #3",null,null,null,"Insert cold wallet address #3",null,null,null,null,null,null,null,null,1]
[null,null,null,null,null,null,null,"Insert hot wallet address #4",null,null,null,"Insert cold wallet address #4",null,null,null,null,null,null,null,null,1]
[null,null,null,null,null,null,null,"Insert hot wallet address #5",null,null,null,"Insert cold wallet address #5",null,null,null,null,null,null,null,null,{"$f":"IF(OR(H25=0,H25=\"Other Contact Person's Name, Address Telephone Number and Email Address(es)\"),0,1)","v":1}]
["Where smart contracts are deployed, please provide a list with the main five smart contract addresses (to be) used by the issuer. \n\nWhere this information is not available, the issuer should state the relevant reason(s).",null,null,null,null,null,null,"Insert smart contract address #1",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(H26=0,H26=\"Other Contact Person's Name, Address Telephone Number and Email Address(es)\"),0,1)","v":1}]
[null,null,null,null,null,null,null,"Insert smart contract address #2",null,null,null,null,null,null,null,null,null,null,null,null,1]
[null,null,null,null,null,null,null,"Insert smart contract address #3",null,null,null,null,null,null,null,null,null,null,null,null,1]
[null,null,null,null,null,null,null,"Insert smart contract address #4",null,null,null,null,null,null,null,null,null,null,null,null,1]
[null,null,null,null,null,null,null,"Insert smart contract address #5",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(H30=0,H30=\"Other Contact Person's Name, Address Telephone Number and Email Address(es)\"),0,1)","v":1}]
["Is the issuer regulated in another jurisdiction? If so, please provide relevant details [including the contact information of the relevant regulatory authority in the said jurisdiction(s) - contact person name/title, organisation name/address, e-mail address and telephone contact details].",null,null,null,null,null,null,"Select",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(H31=0,H31=\"Select\"),0,1)","v":0}]
["Has the issuer conducted an offer via a digital asset issuance before or is the issuer concurrently conducting such an offer? If so, please provide relevant details.",null,null,null,null,null,null,"Select",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(H32=0,H32=\"Select\"),0,1)","v":0}]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(U4:U32)","v":10}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,17]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"U34/U35","v":0.58823529411764708}]

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["Digital Asset Issuance Exemption Form",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Check"]
["DECLARATIONS"]
[]
[]
["We, the undersigned, declare that:"]
[]
[1,"We are duly authorised to complete and submit this exemption form.",null,null,null,null,null,null,null,null,null,null,"Select",null,null,null,null,{"$f":"IF(OR(M7=0,M7=\"Select\"),0,1)","v":0}]
[2,"To the best of our knowledge, the information provided within this form is truthful, accurate and complete and that there are no other facts relevant to this form of which the Bermuda Monetary Authority (Authority or BMA) should be made aware.",null,null,null,null,null,null,null,null,null,null,"Select",null,null,null,null,{"$f":"IF(OR(M8=0,M8=\"Select\"),0,1)","v":0}]
[3,"We shall notify the BMA immediately if the information provided changes in any material way, thus triggering an authorisation requirement pursuant to the Digital Asset Issuance Act 2020.",null,null,null,null,null,null,null,null,null,null,"Select",null,null,null,null,{"$f":"IF(OR(M9=0,M9=\"Select\"),0,1)","v":0}]
[4,"The BMA is hereby being authorised to make such enquiries as it may consider necessary in connection with this form.",null,null,null,null,null,null,null,null,null,null,"Select",null,null,null,null,{"$f":"IF(OR(M10=0,M10=\"Select\"),0,1)","v":0}]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(R7:R11)","v":0}]
["Note: The declaration should be signed electronically (see 'I-Instructions' tab for further details) by two directors, or one director and an officer of the applicant.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"R12/R13","v":0}]
[]
[1]
[]
[]
[]
[null,"Name and e-mail address",null,null,null,null,"Position",null,null,null,null,"Date and signature"]
[]
[]
[]
[2]
[]
[]
[]
[null,"Name and e-mail address",null,null,null,null,"Position",null,null,null,null,"Date and signature"]