[Complete one entry in the register for each nominee director]
Date of entry: ..........
Name of nominee director: ..........
Part 1*
1.
Full name of the person for whom the director is a nominee: ..................................................
2.
Aliases, if any of the person for whom the director is a nominee: ..................................................
3.
Residential address of the person for whom the director is a nominee: ..................................................
4.
Nationality of the person for whom the director is a nominee: ..................................................
5.
Identity card number or passport number of the person for whom the director is a nominee: ..................................................
6.
Date of birth of the person for whom the director is a nominee: ..................................................
7.
Date on which the director became the nominee of the person for whom the director is a nominee: ..................................................
8.
Date on which the director ceased to be a nominee of the person for whom the director is a nominee: ..................................................
9.
Where there is any change to the particulars of the person for whom the director is a nominee —
(a)
the new particulars: ..................................................
(b)
the date on which the particulars changed: ..................................................
Part 2**
1.
Name of the person for whom the director is a nominee: ..................................................
2.
Unique entity number of the person for whom the director is a nominee issued by the Registrar, if any: ..................................................
3.
Address of registered office of the person for whom the director is a nominee: ..................................................
4.
Legal form of the person for whom the director is a nominee: ..................................................
5.
Jurisdiction where, and statute under which, the person for whom the director is a nominee is formed or incorporated: ..................................................
6.
The name of the corporate entity register of the jurisdiction in which the person for whom the director is a nominee is formed or incorporated, if applicable: ..................................................
7.
Identification number or registration number on the corporate entity register of the jurisdiction where the person for whom the director is a nominee is formed or incorporated, if applicable: ..................................................
8.
Date on which the director became the nominee of the person for whom the director is a nominee: ..................................................
9.
Date on which the director ceased to be a nominee of the person for whom the director is a nominee: ..................................................
10.
Where there is any change to the particulars of the person for whom the director is a nominee —
(a)
the new particulars: ..................................................
(b)
the date on which the particulars changed: ..................................................
* Where the person for whom the director is a nominee is an individual, complete Part 1.
** Where the person for whom the director is a nominee is a legal entity, complete Part 2.
