140 DECREE of 12 May 2011 on payment systems with irrevocability of transactions Pursuant to Article 142 of Act No. 284/2009 Coll., on the Payment System, as amended by Act No. 139/2011 Coll. (hereinafter only the Act ), the Czech National Bank stipulates the following regarding the implementation of Article 71(3), Article 72(4) and Article 73b(5) of the Act: Article 1 Subject matter This Decree stipulates a) the specimen application form for authorisation to operate a payment system with irrevocability of transactions (hereinafter only payment system ) and the content of its annexes, b) the specimen form for notification of changes to information given in an application for authorisation to operate a payment system and the content of its annexes and c) the content, form, deadlines and method of provision of information by the operator of a payment system to the Czech National Bank. Article 2 Definitions For the purposes of this Decree: a) certificate of integrity shall mean a document analogous to an extract from the Criminal Register not more than three months old issued by the foreign country, 1. of which a natural person is a citizen as well as by any foreign country in which the said natural person resided for an unbroken period of more than six months during the last three years, 2. in which a legal person has or, during the last three years had, its registered office, as well as by the foreign country in which a legal person has or, during the last three years had a branch, if the body of laws of that country regulate the criminal liability of legal persons, b) business licence certificate shall mean a complete extract, or other document, from the register of entrepreneurs or other register pursuant to another legal rule 1), or from similar registers abroad, containing information valid at the time of submission of the application or notification, including information on any proposal for entry into a relevant register submitted but not effected as of the date of submission of the application or notification, and a document providing authorisation for the performance 1) For example, Act No. 513/1991 Coll., the Commercial Code, as amended; Act No. 455/1991 Coll., on Trade and Entrepreneurial Activities (the Trades Licensing Act), as amended. 1
of activities, if issued pursuant to a different legal regulation, or other analogous document issued by the relevant body of a foreign country, c) financial statements shall mean 1. the annual reports and financial statements either for the last three accounting periods or for the period during which the applicant has been carrying on business if the latter period is shorter than three accounting periods; where the applicant belongs to a consolidated group, the consolidated annual reports and financial statements for the same period shall also be submitted; if, pursuant to another legal rule 2) the financial statements must be verified by an auditor, the audited financial statements shall be submitted, 2. documents on income for the last three years and on assets and liabilities, in the case of a natural person, d) information system shall mean a functional unit ensuring the acquisition, processing, transfer, sharing and storage of information in any form, including the relevant technical equipment, e) business plan shall mean an actually intended plan for the first three accounting periods of business, supported by realistic economic calculations containing financial statement data pursuant to another legal rule 3) together with notes on the individual items thereof, each note containing the basic assumptions on which the plan is based, f) decision on bankruptcy shall mean a decision on bankruptcy pursuant to the Act on Insolvency and its Resolution 4), or an analogous decision pursuant to a different legal rule or a legal rule of a foreign country, g) details about a person shall mean 1. in the case of a legal person, its commercial name, or designation, registered office and identification number if assigned, 2. in the case of a natural person, the name(s) and surname, birth certificate number, date of birth if no birth certificate number has been assigned, and residence address, stating the street name, house number, municipality, part of municipality, postcode and country; in the case of an entrepreneur registered in the Commercial Register, also its commercial name, place of business and identification number if assigned, h) details about professional experience shall mean 1. information about the type of professional experience, 2. identification of the person with which the professional experience is or has been obtained, 3. a job designation and a description of the activities performed, 4. specification of the period of time for which the activities referred to in (3) were performed, 5. consent to the performance of a job required by other legal rules if such consent is necessary, i) details about education shall mean 1. the name and category or type of educational institution, study programme, specialisation of the study programme, duration of the study programme, manner and date of completion of the studies and, where applicable, degrees awarded; and 2. a list of courses, internships and fellowships relevant to the activities of the payment system, stating the year in which they were taken, their specialisation and duration and, where applicable, degrees awarded. 2) Act No. 563/1991 Coll., on Accounting, as amended. 3) Article 18 of the Act on Accounting. 4) For example Act No. 182/2006 Coll., on Insolvency and its Resolution, as amended. 2
Article 3 Application for authorisation to operate a payment system (Regarding Article 71(3) of the Act) (1) An application for authorisation to operate a payment system shall be submitted on a form, the specimen of which is given in Annex 1 hereto. The application shall also include the annexes referred to in paragraphs 2 to 6. (2) The annexes containing basic information about the applicant shall consist of: a) the full wording of the documents of incorporation, b) the business licence certificate, c) financial statements and d) a list of petitions to have a resolution of the applicant s highest body declared invalid in respect of which a court action was not closed with final and conclusive effect as of the date of application if such petitions have been filed and if such petitions might have a significant effect on the further operation of the applicant. (3) The annexes containing information relating to the activities of the payment system shall consist of a) a business plan, b) a business development strategy of the planned payment system, particularly in relation to the proposed business plan and medium-term financial objectives, c) a description of the rules of the risk management system containing at a minimum 1. the proposed organisational structure, defining areas of competence and decision-making powers, within which incompatible positions and procedures to prevent conflicts of interest shall also be defined, 2. strategic and operational management principles, 3. internal control system principles, 4. a description of mechanisms to reduce systemic risk, 5. a description of mechanisms to reduce liquidity risk, 6. the envisaged number of employees who are to perform the planned activities of the payment system, and procedures for the organisational arrangements for individual activities, including a specification of the contact persons who are to receive any notifications given by the Czech National Bank pursuant to Article 73f(4) of the Act, 7. the proposed technical arrangements for individual activities, including an appropriate accounting system and statistical record-keeping systems, and security principles, including security principles for the information system, d) the rules of the payment system at a minimum to the scope pursuant to Article 65 of the Act and e) a list of the participants in the payment system, which shall include data on the person pursuant to Article 2 g) point 1, for every participant in the payment system. (4) The annexes containing information about the directors 5) and persons proposed to hold executive managerial positions with the operator of the payment system shall consist of: 5) Article 2(2) h) of the Act on the Payment System. 3
a) information about the professional experience and information about the education of each director who shall actually manage activities in the area of the operation of the payment system, b) the certificate of integrity issued by a foreign country for each director and c) the questionnaire given in Annex 3 hereto, completed for each director. (5) The annexes containing information about persons with a qualified holding 6) in the applicant and about persons with close links with the applicant shall consist of: a) a list of persons with a qualified holding in the applicant and persons which, through cooperation with another person have a qualified holding in the applicant, including the graphical representation of relations between these persons, with information about these persons, indicating the interest in the applicant, and/or any other form of participation in the applicant, for persons acting in concert also the basis for such acting in concert, and the questionnaire pursuant to Annex 4 hereto completed for each person indicated in this list, b) a list of the persons who are the statutory body, and/or members of the statutory body of each person pursuant to letter a), and the questionnaire pursuant to Annex 3 hereto completed for each person indicated in this list, c) the certificate of integrity issued by a foreign country for each person indicated in letter a) and for each person who is the statutory body, and/or a member of the statutory body of each person pursuant to letter a), d) a business licence certificate for each person pursuant to letter a), e) the financial statements of each person pursuant to letter a), f) information about persons with close links with the applicant and g) the contract 7), on the basis of which the person pursuant to letter a) shall become the controlling person, if such a contract is or has been concluded, or the draft of such contract. (6) If the person with a qualified holding in the applicant pursuant to paragraph 5 a) is a person that is an institution, financial institution or other person performing activities on a financial market with its registered office in a Member State, and this person is subject to supervision by a relevant body in the country in which it has its registered office, the applicant shall submit for this person a) the annex pursuant to paragraph 5 d), and if this person becomes a controlling person controlling the applicant on the basis of a contract to control 7), also the annex pursuant to paragraph 5 g) and b) the original of a statement from the body that performs supervision over the person with a qualified holding in the applicant in the country in which it has its registered office, that it is not aware that the person with a qualified holding in the applicant is not trustworthy. Article 4 (1) If the applicant for authorisation to operate the payment system is a person pursuant to Article 71(2) of the Act, it shall submit the application on the form whose specimen is given in Annex 2 hereto. The application shall also include the annexes pursuant to paragraph 2. (2) The annexes containing information about the applicant shall consist of: 6) Article 2(2) f) of the Act on the Payment System. 7) Article 190b, the Commercial Code. 4
a) the business licence certificate and b) the rules of the payment system. Article 5 Notification of a change to information in the application for authorisation to operate a payment system (Regarding Article 72(4) of the Act) (1) The operator of a payment system shall submit notification of a change in information given in the application for authorisation to operate a payment system or in its annexes on the form whose specimen is given in Annex 1 hereto, if it is a person pursuant to Article 71(1) of the Act, or in Annex 2 hereto, if it is a person pursuant to Article 71(2) of the Act. (2) A notification pursuant to paragraph 1 shall include the documents and information indicated a) in Article 3(2) to (6), if it is a change to information given in an application and its annexes pursuant to Article 3, b) in Article 4(2) if it is a change to information given in an application and its annexes pursuant to Article 4, demonstrating the change to the information. Article 6 Provision of information to the Czech National Bank (Regarding Article 73b(5) of the Act) (1) The operator of the payment system shall provide to the Czech National Bank a) the balance sheet of the operator of the payment system, b) the profit and loss statement of the operator of the payment system and c) information about the fulfilment of conditions under which authorisation to operate the payment system was granted. (2) The operator of the payment system shall provide the information pursuant to paragraph 1 for the calendar year, at the latest by 31 January of the following year. Article 7 Common provisions (1) If a person acts through a representative, a power of attorney or other document proving the representative s authorisation shall be annexed to the application or notification. The authorising person s signature shall be authenticated. (2) The authenticity of a signature on an application, notification and questionnaire must be authenticated. (3) The documents pursuant to Article 3(2) a) and b), Article 3(4) b) and Article 3(5) c) and d) and pursuant to Article 4(2) shall be submitted as originals or as authenticated copies. 5
(4) If the nature of the matter does not allow the submission of an annex to the application as required hereto or the presentation of information on the form, and if this information is not sufficiently evident from the application, the applicant shall state this fact in the application together with the reasons why the annex cannot be submitted or the information given, and shall demonstrate such reasons appropriately. (5) Instead of submitting the prescribed annex, the applicant or reporting person may refer to a precisely identified document which it submitted to the Czech National Bank during the past three years and which meets the requirements laid down herein. (6) A foreign public document shall be authenticated at a higher level (superlegalised), unless stipulated otherwise by an international treaty 8) by which the Czech Republic is bound. This shall not apply to a foreign public document issued by a public authority of a) a Member State 9), or b) a foreign country with which the Czech National Bank has signed a memorandum of understanding; a list of such authorities shall be published by the Czech National Bank in a manner allowing remote access. Article 8 Repealing provisions Decree No. 32/2010 Coll., on payment systems with irrevocability of transactions, is repealed. Article 9 Effect This Decree shall take effect on the date of its promulgation. Governor: Ing. Miroslav Singer, Ph.D., signed in his own hand 8) For example Communication from the Ministry of Foreign Affairs No. 45/1999 Coll., on accession to the convention abolishing the requirement for legalisation of foreign public documents. 9) Article 2(2 a) of the Act on the Payment System. 6
Annex 1 to Decree No. 140/2011 Coll. SPECIMEN Application for authorisation to operate a payment system with irrevocability of transactions (Article 71(1) of the Payment System Act) Notification of a change of information in the application for authorisation to operate a payment system with irrevocability of transactions (Article 72(4) of the Payment System Act) I. ADMINISTRATIVE AUTHORITY 1. Name and address of the administrative authority Name of administrative authority Czech National Bank Registered office Na Příkopě 28, Prague 1, ZIP code 115 03 Mail room Senovážná 3, Prague 1, ZIP code 115 03 II. SUBJECT OF APPLICATION 2. Specification of the subject of the application application for authorisation to operate a payment system with irrevocability of transactions notification of a change of information in the application for authorisation to operate a payment system with irrevocability of transactions III. APPLICANT 1) / TIFYING ENTITY 3. Identification of the applicant/notifying entity Commercial name, or name Identification number 2) Telephone number Registered address (street, house number, town/city, part of town/city, ZIP code and country) Contact details for notification purposes pursuant to Article 73f(4) of the Payment 1) An established legal entity or an already existing legal entity. 2) Where the number has been allocated. 7
System Act (electronic address, telephone number) Unless ruled out by law or the nature of the matter, do you wish to receive correspondence by e-mail c)? If so, please provide your e-mail address: A. Capital IV. ADDITIONAL INFORMATION RELATED TO THE SUBJECT OF THE APPLICATION 4. Information about initial capital of the operator of a payment system with irrevocability of transactions (CZK thousands) Initial capital in total of which Paid-up capital Paid-up share premium Mandatory reserve funds Other funds created from profit distribution, which can be used solely to cover a loss recorded in financial statements The difference between retained earnings given in the financial statement verified by an auditor and approved by a competent body of the operator of the payment system with irrevocability of transactions, whose distribution has not been decided on by the competent body, and accumulated losses, including losses for previous years B. Performed activities 5. List of other activities which the operator of the payment system with irrevocability of transactions performs or intends to perform Performed activities c) Article 19(3) of the Administrative Procedure Code. 8
C. Senior officer of the operator of the payment system with irrevocability of transactions 6. Basic identification of the senior officer of the operator of the payment system with irrevocability of transactions Name(s) and surname and maiden name Birth index number b) /date of birth Nationality Proposed office Place of birth (state, district, and town/city) Permanent address (street, house number, town/city, part of town/city, ZIP code and country) D. List of Annexes 7. List of the numbers of all annexes d) ; for the individual annexes please state references to the relevant provisions of the Decree on payment systems with irrevocability of transactions. V. IDENTIFICATION OF OTHER PERSONS This application is submitted by the applicant/notifying entity 8. Identification of the person acting on behalf of the applicant/notifying entity Designation of office Name(s) and surname Date of birth Permanent address (street, house number, town/city, part of town/city, ZIP code, country) Mailing address, if different from the permanent address (street, house number, town/city, part of town/city, ZIP code, country) d) The annexes to the application must be numbered. The numbers of the annexes in the list must correspond to the numbering of the annexes. 9
This application is submitted by the applicant s/notifying entity s representative 9. Identification of the person representing the applicant/notifying entity Details on the representative e) Name(s) and surname / commercial name, or name f) Date of birth Identification number b) Permanent/registered address (street, house number, town/city, part of town/city, ZIP code, country) Mailing address, if different from the permanent/registered address (street, house number, town/city, part of town/city, ZIP code, country) VI. DECLARATION I hereby declare that the information stated in the application/notification, documents and annexes is truthful, up-to-date and complete. At Date Signature e) For example attorney, notary public or general representative. f) A legal entity shall also state the person through whom it is acting. 10
Annex 2 to Decree No.. 140/2011 Coll. SPECIMEN Application for authorisation to operate a payment system with irrevocability of transactions (Article 71(2) of the Payment System Act) Notification of a change of information in the application for authorisation to operate a payment system with irrevocability of transactions (Article 72(4) of the Payment System Act) I. ADMINISTRATIVE AUTHORITY 1. Name and address of the administrative authority Name of administrative authority Czech National Bank Registered office Na Příkopě 28, Prague 1, ZIP code 115 03 Mail room Senovážná 3, Prague 1, ZIP code 115 03 II. SUBJECT OF APPLICATION 2. Specification of the subject of the application application for authorisation to operate a payment system with irrevocability of transactions notification of a change of information in the application for authorisation to operate a payment system with irrevocability of transactions III. APPLICANT a) /TIFYING ENTITY 3. Identification of the applicant/notifying entity Commercial name, or name Identification number b) Telephone number Registered address (street, house number, town/city, part of town/city, ZIP code and country) Contact details for notification purposes a) An established legal entity or an already existing legal entity. b) Where the number has been allocated. 11
pursuant to Article 73f(4) of the Payment System Act (electronic address, telephone number) Unless ruled out by law or the nature of the matter, do you wish to receive correspondence by e-mail c)? If so, please provide your e-mail address: 4. List of Annexes List of the numbers of all annexes d) ; for the individual annexes please state references to the relevant provisions of the Decree on payment systems with irrevocability of transactions. IV. IDENTIFICATION OF OTHER PERSONS This application is submitted by the applicant/notifying entity 5. Identification of the person acting on behalf of the applicant/notifying entity Designation of office Name(s) and surname Date of birth Permanent address (street, house number, town/city, part of town/city, ZIP code, country) Mailing address, if different from the permanent address (street, house number, town/city, part of town/city, ZIP code, country) This application is submitted by the applicant s/notifying entity s representative 6. Identification of the person representing the applicant/notifying entity Details on the representative e) Name(s) and surname / Commercial name, or name f) c) Article 19(3) of the Administrative Procedure Code. d) The annexes to the application must be numbered. The numbers of the annexes in the list must correspond to the numbering of the annexes. e) For example attorney, notary public or general representative. f) A legal entity shall also state the person through whom it is acting. 12
Date of birth Identification number b) Permanent/registered address (street, house number, town/city, part of town/city, ZIP code, country) Mailing address, if different from the permanent/registered address (street, house number, town/city, part of town/city, ZIP code, country) V. DECLARATION I hereby declare that the information stated in the application/notification, documents and annexes is truthful, up-to-date and complete. At Date Signature 13
Annex 3 to Decree No. 140/2011 Coll. SPECIMEN Questionnaire for assessment of a senior officer of an operator of a payment system with irrevocability of transactions and of other persons I. IDENTIFICATION OF THE PERSON AND OTHER INFORMATION 1. Identification of the person Name(s) and surname Maiden name Birth index Date of birth b) number a) Place of birth (state, district, and town/city) Nationality 2. Stating a legal entity or a natural person, in which the person referred to in item 1 is holding or will hold the position of a senior officer and in which the person is a statutory body or a member of such statutory body operator of the payment system with irrevocability of transactions other entity c) For the other entity, give its commercial name, or name. A. Basic information 3. Description of the placement of the position in the organisational structure of the entity referred to in item 2, proposed changes in its organisational structure, if any, including an organisational chart this information may be submitted as an annex a) Where the number has been allocated. b) Give the date of birth where no birth index number has been allocated. c) E.g. a person having a qualifying holding in the applicant or notifying entity. 14
4. Description of the tasks related to the position, including their expected authorisation and powers (duties, responsibility) d)) B. Earlier applications 5. Information on earlier applications Have you (or another person) applied in the past to a supervisory authority in the Czech Republic for prior consent to perform the duties of a senior officer? If so, please provide details. C. Other personal information 6. Other personal information 6.1 Is your competence to perform legal acts limited? If so, please provide details. 6.2 Have any circumstances occurred preventing you from carrying on a trade pursuant to the act governing trades? If so, please provide details. What offices do you hold in parallel with the performance of the duties of a senior officer? None If you hold any other office in parallel, please provide the details required below: Designation of office Commercial name of the legal entity in which the office is held Identification number d) This description may be replaced by an internal regulation governing the tasks related to the position to be held by the assessed person, including the authorisation and powers ensuing from that position. 15
D. Information on the person s trustworthiness 7. Information on decisions in criminal, administrative or similar proceedings or civil proceedings 7.1 Have you been lawfully convicted of a criminal offence? If so, please provide details in brief and document this information with the relevant decision. 7.2 Has a sanction exceeding CZK 20,000 or prohibition of activity, or another remedial measure or duty to pay damages, been imposed on you by a final decision in the last ten years for a misdemeanour or another administrative offence of violating a legal duty in connection with the performance of employment, office or business activity? 7.3 Have you performed duties as the statutory body or member of the statutory body of a legal entity, or a person authorised to act on behalf of a legal entity on the basis of another fact, or a person controlling a legal entity, at a time when a sanction for an administrative offence or a duty to pay damages was imposed on the legal entity by a final decision in connection with an activity on the financial market? 8. Information on criminal, administrative or similar proceedings 8.1 Have you been prosecuted in the last ten years? If so, please provide details in brief and document this information with the accusation or indictment. 8.2 Have you been subject to administrative or similar proceedings for the violation of a duty relating to the performance of employment, office or business activity or in connection with a prohibition of activity, except proceedings for offences or similar proceedings for which only sanctions of up to CZK 20,000 may be imposed? 9. Information on a decision and commencement of civil proceedings or arbitration proceedings 9.1 State whether a decision in civil proceedings or arbitration proceedings concerning you was issued in the last ten years if such a decision relates to your activities on the financial market or may jeopardise your financial situation, or if such proceedings are under way and have yet to be concluded by a final decision. 16
9.2 In the last ten years, have you been subject to a decision declaring insolvency without the insolvency proceeding being concluded by a decision declaring the debtor not insolvent? If so, please provide details. 10. Other facts that may affect trustworthiness 10.1 In the last ten years, has a legal entity controlled by you been subject to a decision declaring insolvency without the insolvency proceeding being concluded by a decision declaring the debtor not insolvent? If so, please provide the commercial name of the legal entity, its identification number and other details. 10.2 Have you performed duties as the statutory body or member of the statutory or supervisory body of a legal entity, or a person authorised to act on behalf of a legal entity on the basis of another fact, for up to three years before a decision on the insolvency of the entity without the insolvency proceeding being concluded by a decision declaring the debtor not insolvent? If so, please provide the commercial name of the legal entity, its identification number and other details. 10.3 Have you ever had a business licence or other licence suspended or withdrawn, or has a court of law or administrative authority ever refused to grant its consent to your election, nomination or appointment to a position where such consent was a necessary condition for your election, nomination or appointment? 11. Information on the person s trustworthiness from the perspective of activity in professional chambers 11.1 Have you been debarred from a professional association or chamber, including a foreign one, in the last ten years? 11.2 Have you performed the duties as the statutory body, member of the statutory or supervisory body of a legal entity or as a person authorised to act on behalf of a legal entity on the basis of another fact in the last ten years, at a time when the legal entity was debarred from a professional association or chamber, including a foreign one? 17
12. Information relating to a submission of the certificate of integrity issued by a foreign state Have you stayed continuously outside the Czech Republic for a period exceeding 6 months in the past three years? If so, state the country/countries in which you stayed continuously for a period exceeding 6 months in the past three years and enclose originals of certificates of integrity issued by foreign states to the application/notification. List of states concerned: 13. Please state any other facts that could affect your trustworthiness and, where applicable, enclose relevant documents. II. DECLARATION I hereby declare that the information stated in the application and in this annex is truthful, up-to-date and complete. At Date Signature 18
Annex 4 to Decree No. 140/2011 Coll. SPECIMEN Questionnaire relating to the acquisition of or increase in a qualifying holding 1. Basic information about the person having a qualifying holding Name(s) and surname/commercial name, or name I. 2. Designation of a legal entity in which the qualifying holding is being acquired or increased payment system with irrevocability of transactions 3. Questionnaire 3.1 Are you acquiring holdings in name and for your account? If not, please provide details. 3.2 Are you exercising or are you going to exercise the voting rights on behalf of a third party? If so, please state in favour of what person. 3.3 Are you going to assign the voting rights to another person under an agreement or arrangement? If so, please state in favour of what person. 19
3.4 Has an agreement been concluded with a third party, under which you are a subsidiary? Has an agreement been concluded or is an agreement to be concluded, under which you are to become a subsidiary? If so, please provide details. Do you act in concert with another person, which owns holdings in the entity in which the qualifying holding is being acquired or increased or to which the exercise of the voting right has been assigned or which can exercise a significant influence over the management of the entity referred to in item 2? If yes, please provide details of this other person and of the manner of acting in concert. 3.6 Do you have any monetary and other liabilities, which exceed 5% of your capital/assets or may have an effect of the same size? If so, please state: the contracting party, the amount of the liability, the date of creation of the liability, the duration of the liability, the maturity date of the liability including information about default in performance of such liabilities. 4. Information on decisions in criminal, administrative or similar proceedings 4.1 Have you been lawfully convicted of a criminal offence? If so, please provide details in brief and document this information with the relevant decision. 4.2 Has a sanction exceeding CZK 20,000 or prohibition of activity, or another remedial measure or duty to pay damages, been imposed on you by a final decision in the last ten years for a misdemeanour or another administrative offence of violating a legal duty in connection with the performance of employment, office or business activity? 4.3 Have you performed duties as the statutory body or member of the statutory body of a legal entity, or a person authorised to act on behalf of a legal entity on the basis of another fact, or a person controlling a legal entity, at a time when a sanction for an administrative offence or a duty to pay damages was imposed on the legal entity by a final decision in connection with an activity on the financial market? 20
5. Information on criminal, administrative or similar proceedings not covered by item 4 5.1 Have you been prosecuted in the last ten years? If so, please provide details in brief and document this information with the accusation or indictment. 5.2 Have you been subject to administrative or similar proceedings for the violation of a duty relating to the performance of employment, office or business activity or in connection with a prohibition of activity, except proceedings for offences or similar proceedings for which only sanctions of up to CZK 20,000 may be imposed? 6. Information on a decision and commencement of civil proceedings or arbitration proceedings 6.1 State whether a decision in civil proceedings or arbitration proceedings concerning you was issued in the last ten years if such a decision relates to your activities on the financial market or may jeopardise your financial situation, or if such proceedings are under way and have yet to be concluded by a final decision. 6.2 In the last ten years, have you been subject to a decision declaring insolvency without the insolvency proceeding being concluded by a decision declaring the debtor not insolvent? If so, please provide details. 7. Other facts that may affect trustworthiness 7.1 In the last ten years, has a legal entity controlled by you been subject to a decision declaring insolvency without the insolvency proceeding being concluded by a decision declaring the debtor not insolvent? If so, please provide the commercial name of the legal entity, its identification number and other details. 7.2 Have you performed duties as the statutory body or member of the statutory or supervisory body of a legal entity, or a person authorised to act on behalf of a legal entity on the basis of another fact, for up to three years before a decision on the insolvency without the insolvency proceeding being concluded by a decision declaring the debtor not insolvent? If so, please provide the commercial name of the legal entity, its identification number and other details. 21
7.3 Have you ever had a business licence or other licence suspended or withdrawn, or has a court of law or administrative authority ever refused to grant its consent to your election, nomination or appointment to a position where such consent was a necessary condition for your election, nomination or appointment? 8. Information on the person s trustworthiness from the perspective of activity in professional chambers 8.1 Have you been debarred from a professional association or chamber, including a foreign one, in the last ten years? 8.2 Have you performed the duties as the statutory body, member of the statutory or supervisory body of a legal entity or as a person authorised to act on behalf of a legal entity on the basis of another fact in the last ten years, at a time when the legal entity was debarred from a professional association or chamber, including a foreign one? 9. Information relating to a submission of the certificate of integrity issued by a foreign state a) for a natural person Have you stayed continuously outside the Czech Republic for a period exceeding 6 months in the past three years? If so, state the country/countries in which you stayed continuously for a period exceeding 6 months in the past three years and enclose originals of certificates of integrity issued by foreign states to the application/notification. List of states concerned: a) for a legal entity Do you have or did you have an organisational unit outside the Czech Republic in the past three years? If so, give the states concerned and enclose original documents of integrity issued by foreign states to the application/notification. List of states concerned: 22
10. Please state any other facts that could affect your trustworthiness and, where applicable, enclose relevant documents. II. DECLARATION I hereby declare that the information stated in the application, annexes and in this questionnaire is truthful, up-to-date and complete. At Date Signature 23