Questionnaire for Authorizing the Acquisition of Qualifying Participation in an Insurance company and for Establishing the Applicant’s Good Business Reputation Pursuant to Point e) in Paragraph (1) in Section 112 of Act
LX of 2003 on Insurance Institutions and the Insurance Business
A.
In the case of applications for authorizing the acquisition of qualifying participation by natural person(s) 1. Identification data of the Applicant:
a) full name: b) name at birth:
c) date and place of birth (incl. country for foreign citizens): d) mother’s maiden name:
e) type and number of identification document:
f) residential address, duration of stay at each address in the past 5 years: g) correspondence address:
h) citizenship(s):
2. Name and head office of the insurance company in which the Applicant intends to acquire qualifying participation
2 3. Qualified participation to be acquired as specified in paragraph (1) of Article 111 of the Insurance Act. Please
indicate separately the extent of direct and indirect participation and declare how indirect participation will be acquired, if any:
3.1. In case of direct participation
Extent and method of direct participation at the time of submission of application
Extent and method of direct participation to be acquired
3.2. In case of indirect participation1
Detailed description of the extent and method of existing indirect participation:
Detailed description of the extent and method of existing indirect participation to be acquired:
4. List of former business and other relationships between the Applicant and the Insurer in which participation is acquired:
Date/Duration Details of business and other relationships
5. Extent of qualifying participations held by the Applicant in other financial organizations2, year of acquisition, indication of whether the competent supervisory authority rejected any application filed by the Applicant in the past ten years regarding the acquisition of qualifying participation in the current or other financial organization (please attach a copy of the resolution on rejection):
Financial organization Existing participation Participation to be acquired
1 Please list all natural persons, legal entities and other organizations without legal personality through which the Applicant acquires indirect qualifying participation.
2 Financial organizations include organization and persons that provide financial services, auxiliary financial services, investment services,
auxiliary investment services, commodity exchange services, clearing house, central depository, insurance, insurance intermediary services and insurance consulting services, along with voluntary mutual funds, private pension funds, bonded warehouses, investment funds, investment fund managers, venture capital funds, venture capital fund managers, portfolio managers, clearing houses, central depositories and the stock exchanges and their members.
3 6. List of all enterprises (Hungarian and foreign) in which the Applicant has or had in the past 5 years a qualifying participation exceeding 10% - 5% in case of insurers - for at least 6 months. (Please indicate the extent of qualifying participation in the financial organization):
Name and head office of enterprise concerned
Date of acquiring participation and duration
of participation
Extent of direct participation
Extent of indirect participation
7. List of all enterprises (indicating the head office thereof) in which the Applicant was the CEO or held an equivalent position in the past 10 years, specifying the positions for which a special authority license was required (from the supervisory authority/chamber):
Name and head office of enterprise
Position held Duration of holding position (defining year
and month)
Number and date of special authority license
4 8. List of enterprises (indicating the head office thereof) led by the Applicant in the past 10 years which were subjected to bankruptcy or liquidation procedures. Provide the reason of launching procedures along with the way they were closed. Please declare whether your personal liability was established in relation to the debts of enterprise or if an examination for that purpose is still underway:
Name and head office of enterprise Start date of bankruptcy or liquidation procedure Reason of launching bankruptcy or liquidation procedure Way of closing procedure Personal liability established (yes/no)
9. List of all ongoing criminal procedures against the Applicant for crimes defined in Titles VII and VIII, Chapter XV, and Chapters XVII and XVIII of Act IV of 1978 on the Criminal Code in force until 30 June 2013 or Chapters XXVII and XXXV-XLIII of Act C of 2012 on the Criminal Code in which formal charges were made, and list of all foreign ongoing criminal procedures for crime against property and economic crime in which formal charges were made. Furthermore, the list of all binding criminal court decisions made within the period of exemption, indicating the acting authority/court, and briefly describing the operative part of the decision and the facts:
10. List all condemning rulings passed by a court3, authority or chamber in the past 10 years against the Applicant in relation to his/her business activities, briefly outlining the operative clauses of the rulings and the statement of facts:
5 In full awareness of my liability under criminal law, I hereby declare that the information provided herein is true and accurate. Furthermore, I declare that I have disclosed all material facts and data that may be relevant for licensing the acquisition of qualifying participation. Hereby I consent that the Central Bank of Hungary (in Hungarian Magyar Nemzeti Bank) may verify the truthfulness and accuracy of the data provided herein through the organizations it chooses to contact.
Date: ……… ……… (signature)
Signed before us as witnesses:
Witness 1 Witness 2
name: name:
residential address: residential address:
6 B.
In the case of applications for authorizing the acquisition of qualifying participation by a legal entity or legal entities
1. Identification data of the Applicant: a) name, shortened name:
b) head office (in the past 5 years), branch office(s), premises, correspondence address(es): c) trade registry number, date of registration:
d) tax number: e) executive officers:
CEO or equivalent top executive:
executive responsible for order of accounting: chief lawyer:
f) countries in which company pursues business activities:
2. Business activities of the Applicant pursued today and in the past 10 years, highlighting in particular the activities of financial nature specified in certain sector-specific laws4:
3. Name and head office of the insurance company in which the Applicant intends to acquire qualifying participation (or which it intends to co-found):
4. Qualified participation to be acquired based on paragraph (1) of Article 111 of the Insurance Act. Please indicate separately the extent of direct and indirect participation in the table below and declare how indirect participation will be acquired, if any.
4.1. In case of direct participation
Extent and method of direct participation at the time of submission of application
Extent and method of direct participation to be acquired
4 Act LX of 2003 on Insurance Institutions and the Insurance Business (Insurance Act); Act CXXXVIII of 2007 on Investment Enterprises and
Commodity Exchange Service Providers and the Rules of their Activities (Investment Services Act); Act CCXXXVII of 2013 on Credit Institutions and Financial Enterprises (CIFE Act); Act LXXXII of 1997 on Private Pension and Private Pension Funds (Private Pension Act); Act XCVI of 1993 on Voluntary Mutual Funds (Mutual Fund Act); Act CXX of 2001 on the Capital Market (Capital Market Act).
7 4.2. In case of indirect participation
Detailed description of the extent and method of existing indirect participation:
Detailed description of the extent and method of existing indirect participation to be acquired:
5. Description of any equity participation held in any other insurance company at the date of application submission:
Extent of direct participation (%)
Extent of indirect participation (%) Way of indirect participation
6. List of former business and other relationships between the Applicant and the Insurer in which participation is acquired:
Date/Duration Details of business and other relationships
7. Extent of qualifying participations held by the Applicant in other financial organizations5, year of acquisition, indication of whether the competent supervisory authority rejected any application filed by the Applicant in the past 10 years regarding the acquisition of qualifying participation in the current or other financial organization (please attach a copy of the resolution on rejection):
Financial organization Existing participation Participation to be acquired
5 Financial organizations include organization and persons that provide financial services, auxiliary financial services, investment services, auxiliary investment services, commodity exchange services, clearing house, central depository, insurance, insurance intermediary services and insurance consulting services, along with voluntary mutual funds, private pension funds, bonded warehouses, investment funds, investment fund managers, venture capital funds, venture capital fund managers, portfolio managers, clearing houses, central depositories and the stock exchanges and their members.
8 8. Detailed description of the ownership structure of the Applicant, membership in a group; presentation of the structure of that group; in case the Applicant is a member of a holding or syndicate, name and head office of that organization:
9. Bank(s) that manage(s) account of the Applicant (including accounts managed by foreign credit institutions), auditor and professional supervisory authority of the Applicant (indicating name and head office):
10. List of all enterprises (Hungarian and foreign) in which the Applicant has or had in the past 5 years a qualifying participation exceeding 10% - 5% in case of insurers - for at least 6 months. (Please indicate the extent of qualifying participation in the financial organization):
Name and head office of enterprise concerned
Date of acquiring participation and duration
of participation
Extent of direct participation
Extent of indirect participation
11. List of all enterprises in which the Applicant held or holds a qualifying participation of at least 10 % and where the Applicant received a special authority license (from the supervisory authority/chamber):
Name and head office of enterprise concerned Date of acquiring participation and duration of participation Extent of direct participation Extent of indirect participation
Number and date of special authority license
9 13. List all condemning rulings passed by a court6, authority, supervisory authority, chamber or professional interest representation organization in the past 10 years against the Applicant in relation to its business activities, briefly outlining the operative clauses of the rulings and the statement of facts:
In full awareness of my liability under criminal law, I hereby declare that the information provided herein is true and accurate. Furthermore, I declare that I have disclosed all material facts and data that may be relevant for licensing the acquisition of qualifying participation. Hereby I consent that the Central Bank of Hungary (in Hungarian Magyar Nemzeti Bank) may verify the truthfulness and accuracy of the data provided herein through the organizations it chooses to contact.
……… ………
(place and date of duly authorized signature) (duly authorized signature of the Applicant)
10 C.
For the establishment of good business reputation of individuals holding executive positions7 at the Applicant: 1. Identification data:
a) full name: b) name at birth:
c) date and place of birth (and country for foreign citizens): d) mother’s maiden name:
e) type and number of identification document:
f) residential address, duration of stay at each address in the past 5 years: g) correspondence address:
h) citizenship(s):
2. Highest education of the executive officer of the Applicant, also indicating country and educational institution in case of foreigners (name and head office of educational institution):
Qualification Name and head office of educational institution
Year of graduation
3. List of positions and functions held by the executive officer of the Applicant in the past 10 years, in chronological order, indicating the names and addresses of the employers. Please provide a description of the function(s) held, the time spent at each individual employer, indicate main responsibilities and the reason for changing position(s) or leaving the position(s) concerned.
Name and address of employer Function or position held Time spent in position Main position responsibilities Reason of change
7
Persons qualifying as executive officers: basically the individuals who are to be considered as executive officers of legal person pursuant to Section 3:21. of Act V. of 2013 on Civil Code and, for financial institutions, the executive officers specified in the sector-specific acts (Insurance Act, Investment Services Act, CIFE Act, Pension Funds Act, Voluntary Mutual Funds Act, Capital Markets Act, Act CCXXXV. of 2013 on certain financial provider) and, in the case of foreign citizens, also the individuals classified as executive officers as per the laws of the Applicant's home country.
11 4. List of all enterprises (Hungarian and foreign) in which the executive officer of the Applicant has or had in the last 10 years a qualifying participation of at least 10% for more than 6 months. (Please indicate separately the extent of qualifying participations held in financial organizations! If qualifying participation was terminated please declare if such participation of at least 10% was terminated for the benefit of a close relative or a natural person or legal entity in close (business) relationship with the executive officer concerned.):
5. List of enterprises (indicating the head office thereof) for the past 10 years in which the Applicant was CEO or held an equivalent position, or in which he/she had equity participation. Provide the reason of launching procedures along with the way they were closed. Please declare whether the executive officer concerned was found personally liable for the situation that evolved or if a procedure for establishing such liability is still underway:
Name and head office of enterprise Start date of bankruptcy or liquidation procedure Reason of launching bankruptcy or liquidation procedure Way of closing procedure Personal liability established (yes/no)
6. List of all ongoing criminal procedures against the executive officer of the Applicant for crimes defined in Titles VII and VIII, Chapter XV, and Chapters XVII and XVIII of Act IV of 1978 on the Criminal Code in force until 30 June 2013 or Chapters XXVII and XXXV-XLIII of Act C of 2012 on the Criminal Code in which formal charges were made, and list of all foreign ongoing criminal procedures for crime against property and economic crime in which formal charges were made. Furthermore, the list of all binding criminal court decisions made within the period of exemption, indicating the acting authority/court, and briefly describing the operative part of the decision and the facts; and list of all charges made by competent foreign authorities for financial crimes that are also punishable under Hungarian law and briefly outline the facts of the case:
12 12 7. List of all condemning rulings passed by a court8, authority or chamber in the past 10 years against the executive officer of the Applicant in relation to his/her business activities, briefly outlining the operative clauses of the rulings and the statement of facts:
In full awareness of my liability under criminal law, I ……….. the undersigned, hereby declare that the information provided herein is true and accurate. Furthermore, I declare that I have disclosed all material facts and data that may be relevant for licensing the acquisition of qualifying participation. Hereby I consent that the Central Bank of Hungary (in Hungarian Magyar Nemzeti Bank) may verify the truthfulness and accuracy of the data provided herein through the official organs or other organizations it chooses to contact.
Date: ……… ……… (signature)
Signed before us as witnesses:
Witness 1 Witness 2
name: name:
residential address: residential address:
signature: signature:
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