(a) Name

(b) Nationality

(c) NRC No (or) Passport No.

(i) Place of issue

(ii) Date of issue

(iii) Date of expiry

(iv) Number of years in Myanmar

(d) Date of birth

(e) Place of birth

(f) Residential address

Telephone number/s

Fax No

E-mail address

(g) Office name & address

Telephone number/s

Fax No

E-mail address

(h) Job Title

(i) Type of employment

(j) Career history as a representative

(k) Academic and professional qualification

(a) Trade Name

(b) Location of offices

Registered office (H.O)

Telephone number/s

Fax No

E-mail address

(c) Person to be required

(i) Name

(ii) NRC No (or) Passport No

(d) License No.

(a) engaged in securities business as defined in the Law in or outside of Myanmar;
(Answer “Yes” or “No”. If “Yes”, give details.)

(b) been suspended from or disqualified in engaging in securities business in or outside of Myanmar by any authority or lawful organization, or his employer;
(Answer “Yes” or “No”. If “Yes”, give details.)

(c) been convicted of any offence involving fraud in or outside of Myanmar;
(Answer “Yes” or “No”. If “Yes”, give details.)

(d) been declared bankrupt, or compounded with or made an assignment for the benefit of his creditor/s in or outside of Myanmar.
(Answer “Yes” or “No”. If “Yes”, give details.)