SUPPLEMENTARY QUESTIONNAIRE FOR
CHIEF EXECUTIVE/ALTERNATE CHIEF EXECUTIVE/DIRECTOR/
CONTROLLER OF COMPANY APPLYING TO BECOME
AN APPROVED MONEY BROKER
UNDER SECTION 118A OF THE BANKING ORDINANCE
PART ONE: NOTES
1.
Please affix a recent passport size photograph on the space provided
on the right.
2.
If there is insufficient space to complete your answer to any question,
please continue on a separate sheet, specifying the question to which
the sheet relates and adding your signature.
3.
Please note that the Monetary Authority will perform various vetting
procedures in respect of information provided in your completed
questionnaire, and under certain circumstances may request you to
call at the Certificate of No Criminal Conviction Office of the Hong
Kong Police Force for fingerprinting.
4.
Please sign the Declaration in Part Three of this questionnaire.
5.
In this questionnaire:
(i)
Director includes any person who occupies the position of director, whatever the title
of his office.
(ii) “Controller”, in relation to a company means any person who is (a) a minority shareholder controller;
(b) a majority shareholder controller; or
(c) an indirect controller, of the company.
“indirect controller” means any person in accordance with whose directions or instructions
the directors of the company or of another company of which it is a subsidiary are
accustomed to act:
provided that a person shall not be deemed to be a person in accordance with whose
directions or instructions the directors of a company are accustomed to act by reason only
that the directors of the company act on advice given by him in his professional capacity;
“majority shareholder controller” means any person who, either alone or with associate or
associates, is entitled to exercise, or control the exercise of, more than 50% of the voting
power at any general meeting of the company or of another company of which it is a
subsidiary;
“minority shareholder controller” means any person who, either alone or with any associate
of associates, is entitled to exercise, or control the exercise of, 10% or more but not more
than 50% of the voting power at any general meeting of the company of which it is a
subsidiary.
Revised version – May 2015
(iii) Monetary Authority means the Monetary Authority appointed under section 5A of the
Exchange Fund Ordinance (Chapter 66).
PART TWO: QUESTIONNAIRE
1.
Name of the company which is applying to become an approved money broker.
2.
Please state your capacity in the above company.
3.
Please fill in the following personal particulars.
Surname (in English)
Forenames (in English)
Name in Chinese (if any)
Chinese character code number (if any)
Any previous name(s) by which you have
been known
Hong Kong Identity Card Number
Passport Number / Issuing country*
Date of birth (dd/mm/yyyy)
Place of birth
Nationality and how it was acquired (e.g.
birth, naturalization, marriage)
*Only applicable to applicants with no Hong Kong Identity Card
4.
Please provide information for your address(es).
Your residential address
Your previous residential address(es) during
the last 3 years
2
5.
Please describe the particular duties and responsibilities attaching to the position which you
hold or will hold. If you are completing this form in the capacity of director or prospective
director, indicate whether, in your position as director, you have or will have executive
responsibility for the management of the company’s business.
6.
In carrying out your duties or exercising voting power will you be acting on the directions or
instructions of any other person? If so, give particulars.
7.
In how many and what proportion of shares in the company are you beneficially interested?
8.
What proportion of the voting power at any general meeting of the company are you,
whether alone or in concert with others, entitled to exercise or control the exercise of?
9.
Please state your professional and academic qualifications and the years in which they were
obtained:
Professional and academic
qualifications
Issuing institutions
3
Dates obtained
10. Present occupation or employment and occupations and employment during the last 10
years, including the name of employer, the nature of the business, the position held and
relevant dates.
(i)
Details of
Employment
Name of
employer/
corporation
1
(Present employment)
2
3
(ii) Principal business
address
(iii) Nature of
business
(iv) Capacity in which
employed
(v) Commencement
date of
employment
(vi) Date of
termination of
employment (if
applicable)
(vii) Reasons for
termination of
employment
N.A.
N.A.
11. Of what bodies corporate listed in answer to Question 10 are you currently a controller,
director, chief executive or manager?
12. Of what bodies corporate (other than the company and those listed in answer to Question 11)
have you been a controller, director, chief executive or manager at any time during the last
10 years? Give relevant dates.
4
13. Have you been convicted in Hong Kong or elsewhere of an offence involving fraud or
dishonesty? If so, give particulars.
14. Have you, in Hong Kong or elsewhere, been censured, disciplined or publicly criticised by
any regulatory or other authorities or professional body to which you belong or belonged or
have you ever held a practising certificate subject to conditions? If so, give particulars.
15. Have you been concerned with the management or conduct of affairs of any institution
which has been censured, disciplined, or publicly criticised or whose authorization has been
revoked by any regulatory authority in Hong Kong or elsewhere? If so, give particulars.
16. Have you, or has any body corporate, partnership or unincorporated institution with which
you are, or have been, a controller, director, chief executive or manager, been the subject of
an investigation, in Hong Kong or elsewhere, by or at the instigation of a government
department or agency, professional association or other regulatory body? If so, give
particulars.
17. Have you been a controller, director, chief executive or manager of any body corporate,
partnership or unincorporated institution which has been wound up or adjudicated bankrupt
by court while you were associated with it or within one year after you ceased to be
associated with it? If so, give particulars.
18. Have you been a controller, director, or otherwise concerned in the management, of any
company which has been wound up by a court or whose licence or registration, as the case
may be, has been suspended or revoked while you were associated with it or within one year
after you ceased to be associated with it? If so, give particulars.
19. Have you been, or are you presently, or do you expect to be the subject (i.e. plaintiff,
defendant or being joined as a third party) of any legal proceedings (excluding matrimonial
proceedings) ion Hong Kong or elsewhere? If so, give particulars.
5
20. Have you, in Hong Kong or elsewhere, been dismissed or requested to resign from any
office or employment, subject to internal investigation or disciplinary proceedings by your
employer or barred from entry to any profession or occupation? If so, give particulars.
21. Have you failed to satisfy any judgement debt under an order of a court in Hong Kong or
elsewhere or made any compromise or arrangement with your creditors within the last 5
years? If so, give particulars.
22. Have you been adjudicated bankrupt by a court in Hong Kong or elsewhere, or has a
bankruptcy petition ever been served on you? If so, give particulars.
23. Does the body corporate listed in the answer to Question 10 in relation to your present
employment undertake any material business with the company? Please provide information
on the amount and nature of such businesses if they may conflict with your performance of
the functions for which you have appointed to perform.
24. Do you, your spouse or any firm or company in which you or your spouse are interested as
sole proprietor, partner, director, controller, chief executive or manager undertake material
business with the institution? Please provide information on the amount and nature of such
business if they may conflict with your performance of the functions for which approval is
now sought.
25. Are you aware of any other situation or relationship which may conflict with your
performance of such functions? Please provide any other information that are relevant to
this questionnaire.
6
PART THREE: DECLARATION
1.
I certify that the information given above and in any associated documentation is complete
and accurate to the best of my knowledge, information and belief and that there are no other
facts relevant to this questionnaire that should be brought to the attention of the Monetary
Authority.
2.
I undertake that if there is any material change to the information provided in this
questionnaire, or any associated documentation, prior to the Monetary Authority making a
decision in respect of the company’s application to become an approved money broker
under section 118A of the Banking Ordinance, I shall notify the Monetary Authority in
writing as soon as possible.
3.
I confirm that I have read and understood the attached Personal Information Collection
Statement.
4.
I consent to the Monetary Authority using any personal information I have provided in this
questionnaire, and any personal information I may provide in the future, for the purposes
described in the attached Personal Information Collection Statement.
5.
After the company’s application to become an approved money broker under section 118A
of the Banking Ordinance is approved, I undertake to notify the Monetary Authority of any
material changes to, or affecting the completeness or accuracy of, the answers to the
questions above as soon as possible.
Name:___________________________
Position held:________________________
(in block letters)
Signed:__________________________
Date:________________________
7
Personal Information Collection Statement of the Monetary Authority
The Personal Information Collection Statement sets out the policies and practices of the Monetary Authority
(“MA”) with regard to the Personal Data as defined in the Personal Data (Privacy) Ordinance, Cap 486 (the
“PDPO”).
Purpose of Collection and Use
The MA will collect and use the Personal Data provided by you for the exercise of the functions of the MA
as set out in the Banking Ordinance (the “BO”), the principal one of which is to promote the general
stability and effective working of the banking system and the exercise of the powers and duties vested in the
MA under the Securities and Futures Ordinance (the “SFO”), and for carrying out his functions as a
financial regulator.
The MA may, in the performance of his function as a financial regulator or under the BO or the SFO,
require an individual to provide with the MA Personal Data from time to time and failure to supply such
data may result in hindering the MA from performing his functions and in some cases, may constitute an
offence.
Use1 of Personal Data
The MA will treat all Personal Data in accordance with the PDPO. Disclosure and transfer of such data may
however be made to other persons, including other local and overseas regulators as well as government
bodies (including the Hong Kong Police and the Independent Commission Against Corruption), in
accordance with sections 120 and 121 of the BO or as provided under section 378 of the SFO or as required
under the law or pursuant to any regulatory or investigatory assistance arrangements between the MA and
other local or overseas regulators.
For the purpose of carrying out the MA’s regulatory functions, Personal Data may be disclosed by the MA
to relevant Court, Panels, Tribunals and Committees.
Personal Data may be used by the MA and/or disclosed by the MA to the above organisations or bodies for
the purposes of verifying or matching2 those data.
Access to Personal Data
In accordance with the terms of the PDPO and subject to the provisions and exemptions set out in Part VIII
of the PDPO, any individual –


has the right to check whether the MA holds Personal Data about him and the right of access to such
data; and
has the right to require the MA to correct any Personal Data relating to him which is inaccurate.
The MA takes all practicable steps to ensure that an individual can ascertain the MA’s policies and practices
in relation to Personal Data and be informed of the kind of Personal Data held by the MA and the main
purposes for which the Personal Data held by the MA are or are to be used.
In accordance with the PDPO, the MA has the right to charge a reasonable fee for the processing of any
Personal Data access request.
All enquiries regarding the Personal Data provided or requests for access to Personal Data or correction of
Personal Data, should be addressed in writing to:
Personal Data Privacy Officer
Hong Kong Monetary Authority
55/F., Two International Finance Centre
8 Finance Street
Central, Hong Kong
1
2
“Use” as defined in section 2 of the PDPO includes disclose and transfer.
“matching procedure” is defined in section 2 of the PDPO.
8