Employee Director's Particulars

EMPLOYEE DIRECTOR'S PARTICULARS

This form collects required corporate and employment particulars for an individual who serves or will serve as a director and employee of the company. All fields must be completed accurately. Provide additional detail where requested and attach supporting documents where applicable. The information provided will be used for statutory filings, governance records, compliance checks, and internal HR records.

Personal Information

Date of birth:   Nationality:

Personal telephone:   Email address:

National identification / Passport number:   Country of tax residence:

Position & Appointment

Department:   Reporting manager:

Date appointed as director:   Date employment commenced:

Director classification:   Executive   Non-executive   Independent

Business Directorships & Holdings

Do you hold, directly or indirectly, any beneficial interest in the company?  Yes  No

Disclosures, Conflicts & Fitness to Act

Have you ever been subject to a disqualification order, bankruptcy proceeding, or similar restriction on serving as a director?  Yes  No

Have you been convicted of a criminal offence which is unspent or which the company should consider for governance reasons?  Yes  No

Are you a Politically Exposed Person (PEP) or immediate family member of a PEP?  Yes  No

Employment History (most recent first)

Job title:   From:   To:

Job title:   From:   To:

Education & Professional Qualifications

Institution:   Graduation date:

References

Relationship:   Phone:   Email:

Relationship:   Phone:   Email:

Relationship:   Phone:   Email:

Legal Disclosures & Company Policies

At-Will Employment: Where permitted by applicable law, nothing in these particulars creates a contract of employment for any specified term. Employment is at the mutual will of the company and the employee/director and may be terminated in accordance with the company policy and applicable law.

Equal Opportunity: The company provides equal employment opportunity and prohibits unlawful discrimination and harassment on any protected ground. Compliance with company policies and applicable laws is a condition of continuing appointment.

Certification, Consent & Authorization

I certify that the information provided in this form is true, complete and accurate to the best of my knowledge. I acknowledge that any material misstatement, omission or failure to disclose a relevant matter may constitute grounds for disciplinary action, including removal from office or termination of employment.

I authorize the company and its agents to make such enquiries and obtain such information as the company reasonably requires in connection with my appointment and continued service, including verification of my education, employment history, directorships, professional qualifications, criminal records checks and checks with regulatory and governmental bodies where permitted by law.

I consent to the processing and retention of personal data provided in this form for the purposes of governance, regulatory compliance, and employment administration; such processing will be carried out in accordance with applicable data protection laws and the company’s internal policies.

Consent to background checks: I consent   I do not consent

Applicant Certification

By signing below I confirm that I have read and understood the statements above, that the particulars supplied are correct, and that I agree to notify the company promptly should any material changes occur to the information supplied.

Sign Now