Please complete the Fit & Proper Questionnaire belowPlease enable JavaScript in your browser to complete this form.A. Are you an unrehabilitated insolvent, have you entered into a compromise with creditors, are you under debt review, or have you been provisionally sequestrated? *YesNo If yes, include details below *B. Have you ever failed, or are you failing to, manage any financial obligations (including debts) satisfactorily, including civil judgements or pending proceedings which may lead to such a judgement in respect of any unpaid debt? *YesNo If yes, include details below *C. Have you ever accepted civil liability for, or been the subject of a civil judgement in respect of theft, fraud, forgery, uttering a forged document, perjury, misrepresentation or dishonesty under any law? *YesNoD. Have you at any time been removed from an office of trust because of misconduct related to a discharge of that office? *YesNo If yes, please provide details below *E. Have you, at any time been convicted, whether in the Botswana or elsewhere, of theft, fraud, forgery, uttering a forged document, perjury, or any other offence involving dishonesty? *YesNo If yes, include details below *F. Have you at any time been convicted, whether in Botswana or elsewhere, of any other criminal offence? *YesNoIf yes, provide details below *G. Are you for the time being declared by a competent court to be of unsound mind or unable to manage your own affairs? *YesNoIf yes, include details below *H. Have you ever been found guilty of unprofessional conduct by any statutory entity or professional or regulatory body? *YesNoIf yes, include details below *I. Have you ever been refused registration or membership of any professional or statutory body, or had that registration or membership revoked, withdrawn or terminated by that professional or statutory body? *YesNo If yes, include details below *J. Have you ever been dismissed from any office (other than as auditor) or employment, or requested to resign from any office, employment or firm? *YesNo If yes, include details below *K. Have you ever been involved, as a director or member of senior management of a business that has been placed under statutory management or curatorship, in business rescue or in liquidation while you were connected with that organisation, or within one year of that connection? *YesNoIf yes, include details below *L. Have you ever been disqualified from being a director of a company or from acting in the management or conduct of the affairs of any company? *YesNoIf yes, include details below *M. Have you, or a business with which you have been involved in the capacity of director of member of senior management, ever been the subject of frequent or material preventative, remedial or enforcement actions by any regulatory authority? *YesNo If yes, include details below *Title *Name *FirstMiddleLastPosition *Name of firm *Declaration *I have answered the questions above truthfully and honestly, to the best of my knowledge and belief. Should any of the circumstances above change I undertake to inform the Institute timeously.Submit Questionnaire
