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CONFIDENTIAL!CAYMAN ISLANDS MONETARY AUTHORITYReporting Institution:Licence number:Report Period: (Name of person completing form)(Email address)(Telephone number)$(Name of Director or Senior Manager)(Position held)(Date dd/mm/yyyy) (Fax Number)YEARMONTHv1.001.0_04_1200_MSBFORMForm Total numberClient base (B)hStatistical Reporting Form for FSPs conducting relevant financial business - Multiple Lines of Business BankingTrusts Mutual FundsCompany ManagementRegistered Office InsuranceOtherTotal ATotal BNCA%Non-Compliant Accounts Reporting Form DescriptionRequired InformationOptional Information(All 4 digits ie. 2003)    Non-compliant accounts (A)(# only ie 12 = December)NOTES ON COMPLETION!Cayman Islands Monetary AuthorityTel: (345) 949 7089 P.O. Box 10052 APO80e Shedden RoadElizabethan Square Grand CaymanCayman Islandsh2. If you have any difficulty completing this form, please contact the Policy and Development Division 1 at the address/telephone number below. i3. Non-compliant accounts refers to any business relationship for which there is incomplete verification r of the identity of the persons with whom a business relationship has been formed (before 1st September, 2000).YIf submitting electronically ONLY PRINT THIS PAGE, SIGN IT AND RETURN IT TO THE AUTHORITYEmail: NCAform@cimoney.com.ky Percentage$Web Site: www.cimoney.com.ky/NCAform,Summary of Non-compliant account information1. Total Non compliant accounts'2. Percentage of Non-compliant accounts)(Signature of director or senior manager)I certify that this return represents a true and fair view of the company's position at the above reporting date. I undertake that if there are further material factsaffecting the company's affairs which, in my judgement, should be disclosed, I will promptly advise The Cayman Islands Monetary Authority.\1. To be completed by all licensees and registrants, conducting relevant financial business.The Required Non-Compliant Account Reporting Form is a consolidated form to which statistics from all business activities of a licensee should be reported i.e. The Total Number column should include an aggregate of all non-compliant persons e.g. Banking clients, Trusts clients, etc. The Optional Non-Compliant Account Reporting Form provides assistance in identifying the common types of business lines to be reported. Fax: (345) 946 5611 u4. Complete the form annually as at the last day of December and submit by the end of January of the following year.B= x>?N?C@,AyB4DccB ɀ 7bkoq  dMbP?_*+%{x&L&"Times New Roman,Italic"Cayman Islands Monetary Authority - NCA Form&R&"Times New Roman,Italic"Issue 1 - January 2004&~?'~?(~?)~?MN\\cimadc\NTMOPQ225pC 4dXXA4DINU"4< l}-<IUPH dA4 [none] [none]Arial4Pd?ALVIS_MO<Automatic>Pd j.k k m m EXCEL.EXE"LXX `? `?&`cU} $ F} F}  F} F} $ F}  $ F} $ F7www@   @  @@@ @ @     @   @   @  @ ~~~~~AAA B O AA A_  P C AAAAAAAAAAC C C AAAAAAAAAAC AA G"G H$C  KA~ M(@@@@@C AA D  G D  EEEEC  AADG DDDDAC  C  AAAAAAAAAAC  NJAAAAAAC rtzJAAAAAAC u5tzJAAAAAAC {6 tzKZ AAAAAAC {7 tzxZ AAAAAAC |tzJAAAAAAC G9AAAAIGGGGC G:AAAAIGGGGC AAAAAAAAAAC AC AAAAA AAAAAC GAAAAAAAAAC AC AAAAA A GGGGC IAAAAIGGGGC AC AGGGG A GGGGC A}}}C BXZ, , H@H(, , ,UU ,, B B B " #  $ ?@% ?@& ?@' ?@( ?@) ?@* ?@+ ?@, ?@- ?@. ?@/ ?@0 ?@1 ?@2 ?@3  4 5 6  v8 A A  C"AAAAAAAAAAC #AAAAAAAA # AC $g%$hiiiiij$ C%kllllllm% C &k;&llllllm& C 'k-'llllllm' C (k.(llllllm( C )k/)llllllm) C *k0*llllllm* C +k>+llllllm+ C,kllllllm, C -k& -llA -l' -llm- C .k( .llA .l= .llm. C /n) /llA /s2 /llm/ C 0k* 0ll 0A4 0llm0 C 1k+1llllllm1 C 2k,2llllllm2 C3CoppppppqCC 4CCCCCCCCCC 5CCCCCCCCCC 6s100 (0$000000$FFFD00   1 C(  R  C  ]F! 0  h>@ "          7 ERROR - Invalid YearPlease enter a valid year.\Y2003200420052006200720082009201020112012201320142015201620172018201920200f ERROR - Invalid Month&Please enter a valid month (3,6,9,12).46122fhERROR - Invalid value*Please enter a non-negative decimal value.62gg@ ɀ ; z  dMbP?_*+%{x&L&"Times New Roman,Italic"Cayman Islands Monetary Authority - NCA Form&R&"Times New Roman,Italic"Issue 1 - January 2004&~?'~?(~?)~?MHP LaserJet 6P4C 4dXXA4DINU"4 P"MXX `? `?&`cU} $ F} F} F} F} $!F} $F} $ F} I F} $ F;   w   w w w @ @ @ @ @ h@ @ @ @,@,@,@,@,@,@,@,@,@,@@@@@@@ ~~~~~ B OA A L P CAAAAAAC C  CQQQQQQCC ebbbc `C f# dddc~ w C f dddc~ w C f3 dddcC y-D @@ D D B C y [[[STUC < CCC^^^^^^CCCCCCCCCC^^^^^^CRRRRRRCVRRRRVCSRRRRVCSRRRRVCSRRRRVCD1lP$$$888{$  @!@"@#@$@%@&@'@(@)@*@+@,@-@.@/@0@1@2@3@4@5@6@7@8@9@:@ RRRRRRC!RaC"RSSSSRC#RRRRRRC$SSRRRRC%RRRRC&RRRRRRC'SRRRRRC(RRRRRRC)TWXRRRC*TYRRRRC+TYRRRRC,TYRRRRC-TYRRRRC.TYRRRRC/TYRRRRC0TYRRRRC1TYRRRZC2TYRRTRC3TYRRRRC4TYRRRRC5TYRRRRC6CCCCCC7CCCCCC8CCCCCC:n   CPH 0(  >@  B%%!! 7gg@ ɀ )  dMbP?_*+%{x&L&"Times New Roman,Italic"Cayman Islands Monetary Authority - NCA Form&R&"Times New Roman,Italic"Issue 1 - January 2004&~?'~?(~?)~?MHP LaserJet 6P4C 4dXXA4DINU"4 P"dXX `? `?&`cU} F} IF} F} F}  F} $ F} $F} $ F)   w   w w w @ @ ?]  ?] ?] ?] ?] ?] ?] ?] ?]  ?]  ?] ?] ?] ?] ?] ?] ?] ?]  ?]      ~~~~~A B O AA  A L P CAAAAAAAAC C !CQQQQQQQQC CC    T\ # T\  C\  C\  C\ F\ F\ F\ F\ # %  F\ F\ F\ F\ F\ F\ F\ F\ F\ # % F\TYRRRCTYRRRCTYRRRCCCCCCCDlV((((>((((((((W((((((((W ! " # $ % & ' (  CCCCC C!CCCCC!C"C#C$C%C&C'C(C6   CPH0 0(   >@  b,          7gg@ ՜.+,D՜.+,x4 px  ( NameRequired InformationOptional Information  Worksheets $p     Oh+'0  @L X d p|T<p>Optional Information Required Information Name CONFIDENTIAL CAYMAN ISLANDS MONETARY AUTHORITY Reporting Institution: Licence number: Report Period: (Name of person completing form) (Email address) (Telephone number) (Name of Director or Senior Manager) (Position held) (Date dd/mm/yyyy) (Fax Number) YEAR </p>T<p>Optional Information Required Information Name CONFIDENTIAL CAYMAN ISLANDS MONETARY AUTHORITY Reporting Institution: Licence number: Report Period: (Name of person completing form) (Email address) (Telephone number) (Name of Director or Senior Manager) (Position held) (Date dd/mm/yyyy) (Fax Number) YEAR </p>@aH@{@MHY NCA FormsDevelopment Policy | EktContentIDEktContentLanguage EktFolderId EktQuickLinkEktContentTypeEktFolderName EktCmsPath EktExpiryType EktDateCreated EktDateModified EktTaxCategory EktCmsSizeEktSearchableEktEDescriptionEktAML_and_CFTEktContentSubTypeekttaxonomyenabledEktContentID64EktFolderId64EktDisabledTaxCategory  e@ NY@\NYq!DownloadAsset.aspx?id=2147485041Non Compliant Accounts FormAML AML regulations AML/CFT CONFIDENTIAL CAYMAN ISLANDS MONETARY AUTHORITY Reporting Institution: Licence number: Report Period: (Name of person cy  e@ NY@\NY AML/CFT q!DownloadAsset.aspx?id=2147485041Non Compliant Accounts Formptional Information Required Information Name CONFIDENTIAL CAYMAN ISLANDS MONETARY AUTHORITY Reporting Institution: Licence number: Report Period: (Name of person completing form) (Email address) (Telephone number) (Name of DDevelopment Policyi AML/CFT Root Entry F, YO WorkbookޗSummaryInformation(<DocumentSummaryInformation8  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMPXYZT ) !"#$%&