Requirements for Appointments to Senior Positions

Are you aware of any business interests, financial interests, employment obligations, or any other situations which might give rise to conflict of interest or which could in any way impair your independence and ability to discharge your duties effectively in the Proposed Position? ⬜ ⬜ If any of the answers to the questions above is “Yes”, please provide detailed answers for all questions to which you responded “Yes” in the following space with reference to the question concerned. Ref. Detailed Answers Note : If extra space is required to answer any question, the answer shall be written on another paper attached to the Form stating the question and its number and signed by the Candidate. 13. Are there any other material facts that were not provided in this Form that may affect SAMA’s decision regarding your appointment to Proposed Position in the Financial Institution? ⬜ Yes ⬜ No If “Yes, ”please provide details: * The Saudi Arabian Monetary Agency was replaced by the name of Saudi Central Bank in accordance with The Saudi Central Bank Law No. (M/36), dated 11/04/1442H, corresponding 26/11/2020AD . Acknowledgement I hereby acknowledge that I have read all of the Applicable Laws, Regulations ,policies ,and Instructions. I am aware that providing any false or misleading information or documents on the conduct of business or financial activities in the Kingdom to SAMA, any other entity ,or any natural or legal person ,whether on purpose, inadvertently or by negligence, is a punishable violation under the provisions of the relevant laws and regulations. I also acknowledge that the information given in the answers to this Form are complete, right and accurate and in accordance with the laws, regulations, policies, and instructions applicable in the Kingdom, and there is no other relevant material information not disclosed in this Form or its attachments. I undertake that I will provide SAMA with any information or documents SAMA deems necessary to assess the validity of the information provided in this Form within the specified period by SAMA or (10) business days from the date of requesting such information or documents. I also acknowledge and agree that SAMA has the right to request additional information or documents from any third party as it deems appropriate to assess the validity of the information provided in this Form and assess the fitness and propriety of Candidate for the Proposed Position. I undertake that, as long as I am in the Proposed Position, I will notify SAMA of any information or changes that may affect the accuracy, adequacy or completeness of the answers written in this Form within a maximum period of (5) business days from the day of obtaining such information or the occurrence of the change. In case of failing to do so ,SAMA has the right to cancel the no objection if issued and I shall be subject to the prescribed penalties. Name of Candidate Proposed Position Signature Date Attestation by the Financial Institution By attesting this Form, the Financial Institution confirms that the Candidate who signed this Form is fit and proper in accordance with the Requirements for Appointments to Senior Positions in Financial Institutions Supervised by SAMA and the policies and procedures of the Financial Institution in regard to fitness and propriety of individuals. We also confirm the validity of the information provided by the Candidate in this Form. By signing this Form on behalf of the Financial Institution, I confirm that I have carefully read this Form after it has been completed and signed by the Candidate. All certificates, academic and professional qualifications and work experience have been verified and all information provided in this Form is confirmed to be true. Name of Financial Institution Name of The Person in Charge Position Signature Date Stamp by the Financial Institution