Fitness and Propriety Questionnaire Trust Controller (CM262)

Transcription

1 Fitness and Propriety Questionnaire Trust Controller (CM262) Name (Trust) Name of the Corporate Member Membership number (if known) The applicant must initial the bottom of each page of the questionnaire before submitting the application to Lloyd s CM262 (MAY 2016) Page 1 of 5

2 Introduction This questionnaire is to be completed, in block letters, by a trust ( the Trust ) proposing to be a controller of a firm that is, or is applying to become, a corporate member of Lloyd s ( the Corporate Member ). For a new controller application relating to an existing corporate member, please also submit a completed and signed Change of Control Application. Applicant details Name of Trust Is the trustee(s) a limited company or an individual? If limited company please provide the company name, registered number, registered office address and names of the directors. Where individual(s) please provide name(s) and date(s) of birth. What is the nature and purpose of the Trust? Country of Establishment Please indicate percentage controlling interest % equity interest % voting interest % interest in losses Page 2 of 5

3 Do the beneficiaries have any control over the administration of the Trust? Yes No Please provide full names, dates of birth, address and residency of the beneficiaries Please provide the identity of the Donor/Settler. (If individual please provide name and date of birth.) Please provide details of the source of the funds under the trustees control Are the trustees aware of the beneficiaries of the Trust? Yes No If NO, please describe the extent of the discretion and class of persons from whom beneficiaries may be selected. Who has the power to appoint and remove trustees? Please provide names of any Protector(s) or equivalent. Page 3 of 5

4 Please provide the name(s) of the person(s) authorised to sign on behalf of the Trust Please provide details of any limitations on the trustee s power of investment, and who has the voting rights on behalf of the Trust? Declaration I hereby certify that having made all reasonable enquiries, the information supplied to Lloyd s on this form is, to the best of my knowledge and belief, accurate in all material respects and does not omit any information relating to the Trust that might reasonably be considered relevant to the application to become a controller of a corporate member. I hereby undertake and agree that I shall immediately notify Lloyd s of any changes in the information provided in this form which occur after the date of submission of this application. I confirm that I am authorised to sign this form on behalf of the Trust. (This form should be signed by a trustee of the Trust. If the trustee is a limited company, the form should be signed by a director of that company. If the trustee is a partnership, the form should be signed by a partner. Name Position Signature Date DD/MM/YYYY Please initial each page of this questionnaire Page 4 of 5

5 Schedule Please provide the following documents with this Questionnaire. 1 A Fitness & Propriety Questionnaire for all entities i.e. trusts/trustees/intermediate holding companies 2 A copy of the trust deed of the Trust and any subsequent amendments (No Charities) 3 A copy of the last audited accounts of the Trust/Trustee/intermediate holding company (if not audited, then Due Diligence statement required). 4 IF SLP/LLP a Legal opinion stating trust assets and trust may become LLP member/slp Partner Note - All Overseas documentation needs to be translated into English it is required that the translator is an independent party to the application and must be verified. Page 5 of 5