GOVERNMENT GAZETTE

OF THE

REPUBLIC OF NAMIBIA
N$22.80 WINDHOEK - 12 September 2019 No. 6994

CONTENTS
Page
GENERAL NOTICE

No. 362 Namibia Financial Institutions Supervisory Authority: Standards under the Microlending Act, 2018 .. 1
________________

General Notice
NAMIBIA FINANCIAL INSTITUTIONS SUPERVISORY AUTHORITY

No. 362 2019

STANDARDS UNDER THE MICROLENDING ACT, 2018

The Standards, as set out in the Schedule, are issued by the Namibia Financial Institutions Supervisory
Authority (NAMFISA) under section 35(1) of the Microlending Act, 2018 (Act No. 7 of 2018). The
Standards come into effect on the date of publication.

K. S. MATOMOLA
CHIEF EXECUTIVE OFFICER

SCHEDULE

TABLE OF CONTENTS

PART I
INTRODUCTORY PROVISIONS
Citation
Interpretation
PART II
MICROLENDING STANDARDS
ML.S.1
ML.S.2
2 Government Gazette 12 September 2019 6994

PART I
INTRODUCTORY PROVISIONS

1. Citation

The Standards may be cited as Microlending Standards ML.S.1 and ML.S.2 respectively.

2. Interpretation

(1) In the Standards “the Act” means the Microlending Act, 2018, including the regulations
made thereunder, and the standards issued by NAMFISA under the Act; and

(2) any word or expression to which a meaning has been assigned in the Act bears that meaning,
unless the context indicates otherwise.

PART II

MICROLENDING ACT, 2018

THE FORM AND MANNER OF ANY APPLICATION REQUIRED TO BE
MADE UNDER THE ACT

STANDARD ML.S.1
issued by NAMFISA under section 35(1) of the Microlending Act, 2018

1. Definitions

(1) In this Standard -

(a) “Act” means the Microlending Act, 2018, including the regulations made
thereunder, and the standards issued by NAMFISA under the Act;

(b) “microlending branch” means any additional premises, other than the
existent licensed premises, from where microlending business will be
conducted, and it includes any premises at which a microlender allows for
loan applications to be made or submitted; and

(c) “NAMFISA ERS” means the Electronic Regulatory System which facilitates
communication between NAMFISA and the microlending industry.

(2) Words and phrases defined in the Act have the same meaning in this Standard,
unless the context indicates otherwise, including, without limitation, the following
as defined in section 1 of the Act:

(a) banking institution;

(b) branch manager;

(c) credit bureau;

(d) day;

(e) Financial Intelligence Act;

(f) key responsible person;

6994 Government Gazette 12 September 2019 3

(g) licensed premises;

(h) loan agreement;

(i) microlender;

(j) NAMFISA; and

(k) principal officer.

2. Applicability

This Standard is applicable to any person who conducts, or intends to conduct, business as a
microlender in Namibia.

3. Application for registration as a microlender

(1) Every application, in terms of section 5(1) of the Act, to NAMFISA for registration
as a microlender must be made on a form set out under Schedule 1 attached to this
Standard, on the NAMFISA ERS.

(2) The completed form must be submitted with the following documentation:

(a) a certified copy of the applicant’s Income Tax registration certificate and,
if applicable, a certified copy of the applicant’s Value Added Tax (VAT)
registration certificate, issued by the Ministry of Finance;

(b) a certified copy of each natural key responsible person’s certificate of

conduct/crime clearance certificate, issued by such person’s local police, and
which was issued no longer than 12 months prior to the date of application
to NAMFISA;

(c) a certified copy of each natural key responsible person’s identity document
or passport;

(d) a copy of the updated curriculum vitae of the principal officer, a certified
copy of the principal officer’s educational qualifications and proof of his
or her relevant experience, including but not limited to reference letters
from previous employers or clients or certificates of service from previous
employers, or in the absence thereof, a declaration under oath confirming
his or her relevant experience;

(e) proof, from a banking institution, of a bank account in the name of the
applicant;

(f) a copy of the standard written loan agreement pursuant to section 24(2) of
the Act;

(g) where the applicant is a corporate entity or trust, a certified copy of the
memorandum of association and articles, or other instrument constituting
or defining the constitution of the corporate entity or other foundation
documents of the applicant;

(h) proof of source of funds and amount of start-up capital to finance the
microlending business;
4 Government Gazette 12 September 2019 6994

(i) NAMFISA ERS nominations on the form set out under Schedule 2 attached
to this Standard;

(j) a certified copy of the appointment letter of the applicant’s auditor,

accounting officer or bookkeeper. The appointment letter must contain the
physical registered business address and the postal address of the concerned
auditor, accounting officer or bookkeeper, as well as the telephone number,
fax number and e-mail address of such person;

(k) a copy of the microlender’s compliance programme in accordance with the

Financial Intelligence Act, 2012 (Act No. 13 of 2012); and

(l) proof of payment of the non-refundable application fee of N$2 000.00,

payment of which must be made in accordance with the instructions set out
under Schedule 3 attached to this Standard.

(3) Every registered microlender must, within 3 months after registration, submit to
NAMFISA, on the NAMFISA ERS, a certified copy of the certificate of fitness and
registration issued by the relevant local authority, village council, town council or
municipality in respect of the premises from where the microlending business will
be conducted.

4. Application for the change of name, use of another name, use of shortened form or
derivative of the name

(1) Every application by a registered microlender, in terms of section 18 of the Act, to

NAMFISA for the change of the name under which it is registered, use of another
name or use of a shortened form or derivate of a name must be made on a form set
out under Schedule 4 attached to this Standard, on the NAMFISA ERS.

(2) The completed form must be signed by the principal officer or any other key
responsible person.

(3) Where the applicant is a corporate entity or trust, certified copies of the relevant
amended memorandum of association and articles, or other amended instrument
constituting or defining the constitution of the corporate entity or trust or other
amended foundation documents of the applicant evidencing the name change must
be submitted to NAMFISA, on the NAMFISA ERS, within 30 days of the approval
for the change of name by NAMFISA.

5. Application for purchase, amalgamation or transfer of microlending business

(1) Every application, in terms of section 19 of the Act, to NAMFISA for the purchase,
amalgamation or transfer of the microlending business, must be made on a form set
out under Schedule 1 attached to this Standard, on the NAMFISA ERS.

(2) The completed form must be signed by the principal officer, or any other key
responsible person, and submitted together with the following documentation:

(a) a certified copy of the applicant’s Income Tax registration certificate and, if
applicable, a certified copy of the applicant’s VAT registration certificate,
issued by the Ministry of Finance;

(b) a certified copy of each natural key responsible person’s certificate of

conduct/crime clearance certificate, issued by such person’s local police, and
6994 Government Gazette 12 September 2019 5

which was issued no longer than 12 months prior to the date of application
to NAMFISA;

(c) a certified copy of each new natural key responsible person’s identity
document or passport;

(d) if a new principal officer is appointed, a copy of the principal officer’s updated
curriculum vitae, certified copies of the principal officer’s educational
qualifications and proof of his or her relevant experience, including but not
limited to reference letters from previous employers or clients or certificates
of service from previous employers, or in the absence thereof, a declaration
under oath confirming his or her relevant experience;

(e) a signed copy of the agreement for the purchase, amalgamation or transfer
of the microlending business;

(f) proof of source of funds for the purchase of the microlending business;

(g) NAMFISA ERS nominations on the form set out under Schedule 2 attached
to this Standard;

(h) if any of the microlenders involved in the purchase, amalgamation or transfer

is a corporate entity or trust, the memorandum of association and articles,
or other instrument constituting or defining the constitution of the corporate
entity or trust or other foundation documents of the corporate entity, as the
case may be; and

(i) any further information relevant to the purchase, amalgamation or transfer

of ownership of the microlending business.

6. Application to conduct other business on licensed premises

(1) Every application by a registered microlender, in terms of section 20 of the Act, to

NAMFISA for conducting other business on licensed premises must be made on a
form set out under Schedule 5 attached to this Standard, on the NAMFISA ERS.

(2) The completed form must be signed by the principal officer, or any other key
responsible person, and submitted together with the following documentation:

(a) proof, from a banking institution, of a separate bank account opened for
such other business pursuant to section 20(3) of the Act;

(b) a certified copy of the certificate of fitness and registration issued by the
relevant local authority, village council, town council or municipality as
proof that the premises is fit for the envisaged other business activities to be
conducted; and

(c) the printed declaration of the NAMFISA ERS form which must be signed
by the principal officer or any other key responsible person.

7. Application for the opening of additional microlending branches

(1) Every application by a registered microlender, in terms of section 21 of the Act, to

NAMFISA for the opening of an additional microlending branch must be made on a
form set out under Schedule 6 attached to this Standard, on the NAMFISA ERS.
6 Government Gazette 12 September 2019 6994

(2) The completed form must be signed by the principal officer, or any other key
responsible person, and submitted together with the following documentation:

(a) proof of source of funds and the amount to be invested in the envisaged
additional microlending branch; and

(b) the city, town or village and the suburb within the city, town or village
where the additional microlending branch will be located.

(3) The microlender must, within three months of the approval of the additional
microlending branch, submit to NAMFISA a form set out under Schedule 7 attached
to this Standard, on the NAMFISA ERS.

(4) The completed form, as referred to under clause (3) above, must be submitted
together with the following documentation:

(a) a certified copy of the certificate of fitness and registration issued by the
relevant local authority, village council, town council or municipality
pertaining to the additional microlending branch;

(b) a declaration that the office set-up of the additional microlending branch
complies with the basic office infrastructure requirements in terms of the
existence of:

(i) electronic device(s) with subscription to a credit bureau which has

been established in terms of the relevant laws;

(ii) office tables and chairs; and

(iii) filing system(s);

(c) a certified copy of the branch manager’s identity document or passport;

(d) a copy of the updated curriculum vitae of the branch manager, certified
copies of his or her educational qualifications and proof of his or her relevant
experience, including but not limited to reference letters from previous
employers or clients or certificates of service from previous employers, or in
the absence thereof, a declaration under oath confirming his or her relevant
experience;

(e) certified copy of the branch manager’s certificate of conduct/crime clearance

certificate, issued by such person’s local police, and which was issued no
longer than 12 months prior to the date of application to NAMFISA; and

(f) the completed Sections F, G and H and the relevant Declaration under oath
of Schedule 1 attached to this Standard.

8. Manner of submitting applications

All applications made under this Standard must be submitted to NAMFISA both manually
in hard copy as well as electronically on the NAMFISA ERS.

9. Additional information

NAMFISA may require any microlender or applicant that has lodged an application in terms
of any provision under this Standard, to furnish such further information and documents
which NAMFISA may determine reasonably necessary in order to consider the application.
6994 Government Gazette 12 September 2019 7

SUPPORTING SCHEDULES

The following supporting schedules are attached to and form part of this Standard:

Schedule 1: Application for registration as a microlender/purchase/amalgamation/transfer of

microlending business form

Schedule 2: NAMFISA ERS nomination form

Schedule 3: Application fee payment instructions

Schedule 4: Application for change of name/use of alternative name/use of shortened form or

derivative of the name

Schedule 5: Application to conduct other business on licensed premises

Schedule 6: Application for additional microlending branch

Schedule 7: Additional microlending branch post-approval form

8 Government Gazette 12 September 2019 6994

Schedule 1

APPLICATION FOR REGISTRATION AS A MICROLENDER/PURCHASE/

AMALGAMATION/TRANSFER OF MICROLENDING BUSINESS

SECTION A: WHERE THE APPLICANT IS A CORPORATE ENTITY OR A TRUST – DETAILS

OF THE CORPORATE ENTITY/TRUST TO BE PROVIDED

A.1 Full registered name: ___________________________________________________________

A.2 Previously registered name(s): ___________________________________________________

A.3 Trading name(s): ______________________________________________________________

A.4 Corporate entity/trust registration No.: _____________________________________________

A.5 Country of Registration: ________________________________________________________

A.6 If not incorporated in Namibia please provide description of the corporate entity/trust: ________

_______________________________________________________________________________

A.7 Income Tax Registration No. and VAT Registration No., if applicable: ___________________
_______________________________________________________________________________

A.8 Financial year end: _____________________________________________________________

A.9 Nature of business: ____________________________________________________________

A.10 Registered address: ___________________________________________________________

A.11 Principal place of business: _____________________________________________________

A.12 Contact person: ______________________________________________________________

A.13 Postal address: _______________________________________________________________

A.14 Telephone No: _______________________________________________________________

A.15 Fax No: ____________________________________________________________________

A.16 Mobile No: _________________________________________________________________

A.17 Is the entity/trust subject to financial services regulation in a foreign country or a financial
services intermediary?: _____________________________________________________________

A.18 If yes, which jurisdiction: ______________________________________________________

A.19 Name of foreign regulator(s): ___________________________________________________

6994 Government Gazette 12 September 2019 9

SECTION B: WHERE THE APPLICANT IS A CORPORATE ENTITY OR A TRUST –

(HONESTY AND INTEGRITY QUESTIONNAIRE)

to be provided in respect of the applicant where the applicant is a corporate entity or trust, as well
as for each shareholder where the shareholder is a legal person

If the answer to any of the questions is yes, provide full details on a separate page and attach certified
documents to the form:

YES NO
Has any adverse finding been made against the corporate entity/trust/legal person
within a period of ten years preceding the date of application in any civil or
1 criminal proceedings by a court of law (whether in Namibia or elsewhere), in
which the entity/trust/legal person has been found to have acted fraudulently,
dishonestly, unprofessionally, dishonorably or in breach of a fiduciary duty?
Has the corporate entity/trust/legal person within a period of ten years preceding
the date of application, been found guilty by any professional, financial services
2
industry or regulatory body (whether in Namibia or elsewhere), of an act of
dishonesty, negligence, incompetence or mismanagement?
Has the corporate entity/trust/legal person within a period of ten years preceding
the date of application, been denied membership of any body referred to in
3
question 2 above on account of an act of dishonesty, negligence, incompetence
or mismanagement?
Has the corporate entity/trust/legal person within a period of ten years preceding
the date of application, been found guilty by any regulatory or supervisory body
4 (whether in Namibia or elsewhere), or has an authorization to carry on business
been refused, suspended or withdrawn by any such body on account of an act of
dishonesty, negligence, incompetence or mismanagement?
Has the corporate entity/trust/legal person at any time prior to the date of
application been disqualified or prohibited by any court of law (whether in
5 Namibia or elsewhere) from taking part in the management of any other corporate
entity or other statutorily created, recognized or regulated body, irrespective
whether such disqualification has since been lifted or not?
Has the corporate entity/trust/legal person been the subject of any investigation or
disciplinary proceedings or has administrative action been taken or administrative
6 penalties been imposed by any regulatory authority, professional or government
body, agency, exchange or self-regulatory organisation (whether in Namibia or
elsewhere)?
Has the corporate entity/trust/legal person ever been refused authorization to
carry on business by any regulatory body (whether in Namibia or elsewhere),
7
or has such authorization ever been suspended or revoked by any such body,
because of negligence, incompetence or mismanagement?
Has the corporate entity/trust/legal person ever been placed under judicial
8
management, insolvency, liquidation or any other processes of a similar nature?
Has the corporate entity/trust/legal person ever been convicted of an offence or
found to be liable under the Financial Intelligence Act, 2012 (Act No. 13 of 2012),
and/or the Prevention of Organized Crime Act, 2004 (Act No. 29 of 2004) and/or
9
the Prevention and Combating of Terrorist and Proliferation Activities Act, 2014
(Act No. 4 of 2014) and/or any other similar Acts describing similar offences and/
or liability in any other country?
Does the corporate entity/trust/legal person have any additional information,
10 which should be brought to NAMFISA’s attention, which may have an impact on
the evaluation by NAMFISA of the corporate entity/trust/legal person’s conduct?
10 Government Gazette 12 September 2019 6994

SECTION C: WHERE THE APPLICANT IS A CORPORATE ENTITY OR A TRUST - SOURCE

OF FUNDS AND AMOUNT OF START-UP CAPITAL:

C.1 Source of Funds: ______________________________________________________________

C.2 Amount of start-up capital: ______________________________________________________

NB: Kindly note that all source of funds must be properly and thoroughly supported with
documentary evidence of how the money was earned, i.e. what activities were conducted to
generate the funds.

DECLARATION BY APPLICANT WHERE THE APPLICANT IS A CORPORATE ENTITY

OR A TRUST

I, ___________________________________________________________ (full names) in my

capacity as _____________________________________ of the applicant referred to herein, hereby
declare under oath/affirm as follows:

This statement consisting of _____________ pages, was completed by me. The contents of this
statement are true to the best of my knowledge and belief.

I undertake that, as long as I continue to be a ____________________________ of the entity/trust, I

will notify NAMFISA of any material changes to, or affecting the completeness or accuracy of, the
information supplied to NAMFISA as soon as possible, but in any event no later than 30 days from
the day that the changes come to my attention.

I know and understand the content of this declaration. I do not have objections to taking the prescribed
oath/affirmation. I consider the prescribed oath/affirmation to be binding on my conscience.

_________________________________________
SIGNATURE OF DEPONENT

I hereby declare that the deponent has sworn/affirmed to and signed the declaration in my presence at
_____________________ on the ____ day of ____________________ 20 ____ and he/she declared
as follows: that the facts herein contained fall within his or her personal knowledge and that he/she
understands the contents hereof; that he/she has no objection to taking the oath/affirmation; that he/
she regards the oath/affirmation as binding on his/her conscience.

_________________________________________
COMMISSIONER OF OATHS

FULL NAMES: __________________________________________________________________

CAPACITY: ____________________________________________________________________

ADDRESS: _____________________________________________________________________
6994 Government Gazette 12 September 2019 11

SECTION D: WHERE THE APPLICANT IS A SOLE PROPRIETOR OR A PARTNERSHIP

- DETAILS OF EVERY NATURAL PERSON WITH AN OWNERSHIP INTEREST TO BE
PROVIDED

to be provided for each natural person/partner

D.1 Full name of person with ownership interest: ________________________________________

_______________________________________________________________________________

D.2 Previous surname(s): ___________________________________________________________

D.3 Nature of ownership interest: ____________________________________________________

D.4 Trading name(s): ______________________________________________________________

D.5 Nationality of person with ownership interest: _______________________________________

D.6 Identification No/Passport No: ___________________________________________________

D.7 Date of Birth: _________________________________________________________________

D.8 Place of Birth: ________________________________________________________________

D.9 Income Tax Registration No. and VAT Registration No., if applicable: ___________________

_______________________________________________________________________________

D.10 Occupation: ________________________________________________________________

D.11 Residential address: ___________________________________________________________

D.12 Business address: _____________________________________________________________

D.13 E-mail: _____________________________________________________________________

D.14 Telephone No: _______________________________________________________________

D.15 Mobile No: _________________________________________________________________

D.16 Fax No: ____________________________________________________________________

SECTION E: WHERE THE APPLICANT IS A SOLE PROPRIETOR OR A PARTNERSHIP -

SOURCE OF FUNDS AND AMOUNT OF START-UP CAPITAL:

E.1 Source of Funds: ______________________________________________________________

E.2 Amount of start-up capital: ______________________________________________________

NB: Kindly note that all source of funds must be properly and thoroughly supported with
documentary evidence of how the money was earned, i.e. what activities were conducted to
generate the funds.
12 Government Gazette 12 September 2019 6994

DECLARATION BY APPLICANT WHERE THE APPLICANT IS A SOLE PROPRIETOR

OR A PARTNERSHIP

I, ___________________________________________________________ (full names) hereby

declare under oath/affirm as follows:

This statement consisting of _____________ pages, each initialed by me. The content of this
statement is true and correct to the best of my knowledge and belief.

I undertake that, as long as I continue to be ______________________________________ (state

designation) of the institution, I will notify NAMFISA of any material changes to, or affecting the
completeness or accuracy of, the information supplied to NAMFISA in this statement as soon as
possible, but in any event no later than 30 days from the day that the changes come to my attention.

I know and understand the content of this declaration. I do not have objections to taking the prescribed
oath/affirmation. I consider the prescribed oath/affirmation to be binding on my conscience.

_________________________________________
SIGNATURE OF DEPONENT

I hereby declare that the deponent has sworn/affirmed to and signed this statement in my presence at
_____________________ on the ____ day of ____________________ 20 ____ and he/she declared
as follows: that the facts herein contained fall within his or her personal knowledge and that he/she
understands the contents hereof; that he/she has no objection to taking the oath/affirmation; that he/
she regards the oath/affirmation as binding on his/her conscience.

_________________________________________
COMMISSIONER OF OATHS

FULL NAMES ___________________________________________________________________

CAPACITY _____________________________________________________________________

ADDRESS ______________________________________________________________________

Initialling of each page by Commissioner of Oaths and deponent

SECTION F: PRINCIPAL OFFICER, BRANCH MANAGER AND OTHER NATURAL KEY

RESPONSIBLE PERSON

To be provided for the principal officer and, if applicable, each branch manager and other natural
key responsible person (directors/trustees)

F.1 Full name(s): _________________________________________________________________

F.2 Previous surname(s): ___________________________________________________________

F.3 Nationality: __________________________________________________________________

F.4 Identification/ Passport No.: _____________________________________________________

F.5 Occupation: __________________________________________________________________

6994 Government Gazette 12 September 2019 13

F.6 Date appointed: _______________________________________________________________

F.7 Residential address: ____________________________________________________________

F.8 Business address: ______________________________________________________________

F.9 E-mail: ______________________________________________________________________

F.10 Telephone No: _______________________________________________________________

F.11 Mobile No: __________________________________________________________________

F.12 Fax No: ____________________________________________________________________

F.13 Relation to applicant: __________________________________________________________

SECTION G: NATURAL KEY RESPONSIBLE PERSON’S HONESTY AND INTEGRITY

QUESTIONNAIRE

Full Name(s) of Natural Person: ______________________________________________________

If the answer to any of the questions is yes, provide full details on a separate page and attach certified
documents to the form:

YES NO
Has any adverse finding been made against you within a period of ten years
preceding the date of application in any civil or criminal proceedings by a court
1 of law (whether in Namibia or elsewhere), in which you were found to have
acted fraudulently, dishonestly, unprofessionally, dishonorably or in breach of a
fiduciary duty?
Have you within a period of ten years preceding the date of application been
found guilty by any professional, financial services industry or regulatory
2
body (whether in Namibia or elsewhere), of an act of dishonesty, negligence,
incompetence or mismanagement?
Have you within a period of ten years preceding the date of application been
3 denied membership of any body referred to in question 2 above on account of an
act of dishonesty, negligence, incompetence or mismanagement?
Have you within a period of ten years preceding the date of application been
found guilty by any regulatory or supervisory body (whether in Namibia or
4 elsewhere), or has an authorization to carry on business been refused, suspended
or withdrawn by any such body on account of an act of dishonesty, negligence,
incompetence or mismanagement?
Have you at any time prior to the date of application been disqualified or prohibited
by any court of law (whether in Namibia or elsewhere) from taking part in the
5 management of any corporate entity or other statutorily created, recognized or
regulated body, irrespective whether such disqualification has since been lifted
or not?
Have you been the subject of any investigation or disciplinary proceedings or has
administrative action been taken or administrative penalties been imposed by any
6
regulatory authority, professional or government body or agency, an exchange or
self-regulatory organisation (whether in Namibia, or elsewhere)?
Have you ever been refused authorization to carry on business by any regulatory
body (whether in Namibia or elsewhere), or has such authorization ever been
7
suspended or revoked by any such body, because of negligence, incompetence
or mismanagement?
Are you subject to an order of a competent court holding you to be mentally unfit
8
or disordered?
14 Government Gazette 12 September 2019 6994

Have you within a period of ten years preceding the date of application been
9 removed from office or left office on account of misconduct relating to fraud,
theft or the misappropriation of money, whether in Namibia or elsewhere?
Have you within a period of ten years preceding the date of application received
10
a grant of amnesty or free pardon for any offence?

11 Has your estate ever been sequestrated?

Have you ever been convicted of an offence or found to be liable under the
Financial Intelligence Act, 2012 (Act No. 13 of 2012), and/or the Prevention
of Organized Crime Act, 2004 (Act No. 29 of 2004), and/or the Prevention and
12
Combating of Terrorist and Proliferation Activities Act, 2014 (Act No. 4 of 2014)
and/or any other similar Acts describing similar offences and/or liability in any
country?
Have you within a period of five years preceding the date of application been
13
adversely listed on a Credit Bureau (whether in Namibia or elsewhere)?
Have you previously been appointed as a Principal Officer or Director in the
financial services industry or as a Branch Manager in the microlending industry?
14
If yes, provide more information, i.e. duration, which company, etc.

Are you involved in other corporate entities as a Director, Shareholder, Member,

15 Trustee, etc.? If yes, provide more information, i.e. duration, which company,
etc.
Has any corporate entity in respect of which you are or were a Member,
Shareholder, Director, Trustee or officer ever been convicted of an offence or
found to be liable under the Financial Intelligence Act, 2012 (Act No. 13 of
16 2012), and/or the Prevention of Organized Crime Act, 2004 (Act No. 29 of 2004),
and/or the Prevention and Combating of Terrorist and Proliferation Activities
Act, 2014 (Act No. 4 of 2014) and/or any other similar Acts describing similar
offences and/or liability in any country?
Do you have any additional information, which should be brought to NAMFISA’s
17 attention, which may have an impact on the evaluation by NAMFISA of your
good character and integrity?

SECTION H: COMPETENCE OF PRINCIPAL OFFICER, BRANCH MANAGER AND OTHER

NATURAL KEY RESPONSIBLE PERSON

Full name(s) of Principal Officer/Branch Manager/other natural key responsible person: ________
_______________________________________________________________________________

_______________________________________________________________________________

H.1 Training (complete table below):

Qualification Institution Date obtained

H.2 Experience (complete table below):

Relevant employment history and/or experience in the industry: (To be supported with proof of
relevant experience, included but not limited to reference letters from previous employers or clients
or certificates of service from previous employers). Enclose detailed Curriculum Vitae (CV) of the
Principal Officer, Branch Manager and other natural key responsible person.
6994 Government Gazette 12 September 2019 15

Position held Employer Contact Details Period

DECLARATION BY PRINCIPAL OFFICER, BRANCH MANAGER AND/OR OTHER

NATURAL KEY RESPONSIBLE PERSON

I, ___________________________________________________________ (full names) hereby

declare under oath/affirm as follows:

This statement consisting of _____________ pages, each initialed by me. The content of this
statement is true and correct to the best of my knowledge and belief.

I undertake that, as long as I continue to be ______________________________________ (state

designation) of the institution, I will notify NAMFISA of any material changes to, or affecting the
completeness or accuracy of, the information supplied to NAMFISA in this statement as soon as
possible, but in any event no later than 30 days from the day that the changes come to my attention.

I know and understand the content of this declaration. I do not have objections to taking the prescribed
oath/affirmation. I consider the prescribed oath/affirmation to be binding on my conscience.

_________________________________________
SIGNATURE OF DEPONENT

I hereby declare that the deponent has sworn/affirmed to and signed this statement in my presence at
_____________________ on the ____ day of ____________________ 20____ and he/she declared
as follows: that the facts herein contained fall within his or her personal knowledge and that he/she
understands the contents hereof; that he/she has no objection to taking the oath/affirmation; that he/
she regards the oath/affirmation as binding on his/her conscience.

_________________________________________
COMMISSIONER OF OATHS

FULL NAMES ___________________________________________________________________

CAPACITY _____________________________________________________________________

ADDRESS ______________________________________________________________________

Initialling of each page by Commissioner of Oaths and deponent

16 Government Gazette 12 September 2019 6994

SECTION I: ADDITIONAL FILE ATTACHMENTS

Additional file Certified copy of applicant’s Income Tax registration certificate and,
attachments if applicable, the VAT registration certificate
Certified copies of each natural key responsible person’s certificate of
conduct/crime clearance certificate
Certified copies of each natural key responsible person’s identity
document or passport
Copy of Principal Officer’s and/or Branch Manager’s and/or natural
key responsible person’s updated curriculum vitae
Certified copies of the Principal Officer’s and/or Branch Manager’s
and/or natural key responsible person’s educational qualifications
Proof of Principal Officer’s and/or Branch Manager’s and/or natural
key responsible person’s relevant experience
Proof from a banking institution of a bank account in the name of the
applicant
Copy of the standard written loan agreement

Certified copies of the corporate entity’s/trust’s memorandum of

association and articles or other instrument constituting or defining
the constitution of the corporate entity/trust or other foundation
documents
Proof of source of funds to finance the microlending business

NAMFISA ERS nomination form

Certified copy of the appointment letter of the applicant’s auditor,

accounting officer or bookkeeper
Copy of the applicant’s compliance programme

Proof of payment of the applicant fee

Copy of the agreement of purchase, amalgamation or transfer of

microlending business
Proof of source of funds for the purchase of the microlending business

Where any microlender involved in the purchase, amalgamation or

transfer is a corporate entity/trust, certified copies of the corporate
entity’s/trust’s memorandum of association and articles or other
instrument constituting or defining the constitution of the corporate
entity/trust or other foundation documents
6994 Government Gazette 12 September 2019 17

Schedule 2

NAMFISA ELECTRONIC REGULATORY SYSTEM (ERS) NOMINATION FORM

Registered name:  

NAMFISA Registration No:  

List of ERS user nominees:

  Name of Nominee Designation (i.e. Principal E-mail Address
Officer, Director, Member
or Owner/etc.)
1      
2      
3      
4      
5      
6      
7      
8      
9      
10      
Authorised Signature (Chief Executive Officer/Managing Director/Owner/Principal Officer):
Designation:
Please print name and sign below:
Name (print)
Signature  
Date
18 Government Gazette 12 September 2019 6994

Schedule 3

APPLICATION FEE PAYMENT INSTRUCTIONS

The application fee must be paid into the following bank account:

Name of Bank: Standard Bank

Account name: NAMFISA
Account number: 241440351
Branch: Gustav Voigts
Branch Code: 082772
Reference: (Name of microlending business)
6994 Government Gazette 12 September 2019 19

Schedule 4

APPLICATION FOR CHANGE OF NAME/USE OF ALTERNATIVE NAME/USE OF

SHORTENED FORM OR DERIVATIVE OF THE NAME

Registered name:  
 
 
NAMFISA Registration No:

Proposed name:  
 
 
Reason for proposed new name /change of name /  
use of alternative name / use of shortened form or  
derivative of the name:
Attach Original License or, if lost, a sworn  
declaration to that effect
By signing this document I confirm that all the above information is true and accurate and can be relied on
and that I will disclose all necessary material information that may be required by NAMFISA.

SIGNED ON BEHALF OF THE APPLICANT:

Name:
Capacity:
Signature:
20 Government Gazette 12 September 2019 6994

Schedule 5

APPLICATION TO CONDUCT OTHER BUSINESS ON LICENSED PREMISES

Section A
 
Registered name:

NAMFISA Registration No:

Description of envisaged other business to be  
conducted on licensed premises:  
 
Reason for conducting envisaged other business on  
licensed premises:  
 
Additional file attachments:

Attach certified copy of Certificate of Fitness and

Registration issued by the relevant local authority,
village council, town council or municipality as
proof that the premises is fit for the envisaged other  
activities to be conducted  
Attach proof from a banking institution, of a separate
bank account opened for such other business
Section B
By signing this document I confirm that all the above information is true and accurate and can be relied on
and that I will disclose all necessary material information that may be required by NAMFISA.

SIGNED ON BEHALF OF THE APPLICANT:
Name:
Capacity:
Signature:
6994 Government Gazette 12 September 2019 21

Schedule 6

APPLICATION FOR ADDITIONAL MICROLENDING BRANCH

SECTION A: WHERE THE APPLICANT IS A CORPORATE ENTITY OR A TRUST – DETAILS

OF THE CORPORATE ENTITY/TRUST TO BE PROVIDED

A.1 Full registered name: ___________________________________________________________

A.2 Trading name(s): ______________________________________________________________

A.3 NAMFISA registration No.: _____________________________________________________

A.4 Registered address: ____________________________________________________________

A.5 Principal place of business: _____________________________________________________

A.6 Contact person: _______________________________________________________________

A.7 Postal address: ________________________________________________________________

A.8 Telephone No: ________________________________________________________________

A.9 Fax No: _____________________________________________________________________

A.10 Mobile No: _________________________________________________________________

A.11 Physical address of additional branch: _____________________________________________

_______________________________________________________________________________

A.12 Description of additional branch (for example, will it be an in-store kiosk or a stand-alone
additional branch): ________________________________________________________________

_______________________________________________________________________________

SECTION B: WHERE THE APPLICANT IS A SOLE PROPRIETOR OR A PARTNERSHIP

– DETAILS OF EVERY NATURAL PERSON WITH AN OWNERSHIP INTEREST TO BE
PROVIDED

to be provided for each natural person/partner

B.1 Full name of person with ownership interest:

_______________________________________________________________________________

B.2 Trading name(s): ______________________________________________________________

B.3 NAMFISA registration No: _____________________________________________________

B.4 Previous surname(s): ___________________________________________________________

B.5 Nationality: __________________________________________________________________

B.6 Identification No/Passport No: ___________________________________________________

22 Government Gazette 12 September 2019 6994

B.7 Occupation: _________________________________________________________________

B.8 Residential address: ____________________________________________________________

B.9 Business address: _____________________________________________________________

B.10 E-mail: _____________________________________________________________________

B.11 Telephone No: _______________________________________________________________

B.12 Mobile No: _________________________________________________________________

B.13 Fax No: ____________________________________________________________________

B.14 Physical address of additional branch: ____________________________________________

_______________________________________________________________________________

B.15 Description of additional branch (for example, will it be an in-store kiosk or a stand-alone
additional branch): ________________________________________________________________

_______________________________________________________________________________

SECTION C: SOURCE OF FUNDS TO FINANCE ADDITIONAL MICROLENDING BRANCH:

C.1 Source of Funds: ______________________________________________________________

C.2 Amount with which operations of additional branch is financed:

_______________________________________________________________________________

NB: Kindly note that all source of funds must be properly and thoroughly supported with
documentary evidence of how the money was earned, i.e. what activities were conducted to
generate the funds.

CERTIFICATION OF COMPLIANCE

On behalf of the applicant...…………………..………………. (name of microlender) I, the

undersigned, ………………………………………………..…. (full names), in my capacity as
principal officer, do hereby confirm that all the requirements of the Act have been complied with in
full and that appropriate procedures have been implemented to ensure on-going compliance.

I am not aware of any substantial non-compliance with the requirements of the Act.

_____________________________________
Signature

Date: _______________________________

Name: _______________________________
6994 Government Gazette 12 September 2019 23

SECTION D: BRANCH MANAGER, IF ALREADY APPOINTED AT THE TIME OF THE

APPLICATION

D.1 Full name(s): _________________________________________________________________

D.2 Previous surname(s): ___________________________________________________________

D.3 Nationality: __________________________________________________________________

D.4 Identification/ Passport No.: _____________________________________________________

D.5 Previous Occupation: __________________________________________________________

D.6 Date appointed: _______________________________________________________________

D.7 Residential address: ___________________________________________________________

D.8 Business address: _____________________________________________________________

D.9 E-mail: _____________________________________________________________________

D.10 Telephone No: _______________________________________________________________

D.11 Mobile No: _________________________________________________________________

D.12 Fax No: ____________________________________________________________________

D.13 Relation to applicant: __________________________________________________________

D.14 Training (complete table below):

Qualification Institution Date obtained

D.15 Experience (complete table below):

Relevant employment history and/or experience in the industry: (To be supported with proof of
relevant experience, including but not limited to reference letters from previous employers or clients
or certificates of service from previous employers). Enclose detailed Curriculum Vitae (CV) of the
Branch Manager.

Position held Employer Contact Details Period

24 Government Gazette 12 September 2019 6994

DECLARATION BY APPLICANT WHERE THE APPLICANT IS A CORPORATE ENTITY

OR A TRUST

I, ___________________________________________________________ (full names) in my

capacity as _____________________________________ of the applicant referred to herein, hereby
declare under oath/affirm as follows:

This statement consisting of _____________ pages, was completed by me. The contents of this
statement are true to the best of my knowledge and belief.

I undertake that, as long as I continue to be a ____________________________ of the entity, I

will notify NAMFISA of any material changes to, or affecting the completeness or accuracy of, the
information supplied to NAMFISA as soon as possible, but in any event no later than 30 days from
the day that the changes come to my attention.

I know and understand the content of this declaration. I do not have objections to taking the prescribed
oath/affirmation. I consider the prescribed oath/affirmation to be binding on my conscience.

_________________________________________
SIGNATURE OF DEPONENT

I hereby declare that the deponent has sworn/affirmed to and signed the declaration in my presence at
_____________________ on the ____ day of ____________________ 20____ and he/she declared
as follows: that the facts herein contained fall within his or her personal knowledge and that he/she
understands the contents hereof; that he/she has no objection to taking the oath/affirmation; that he/
she regards the oath/affirmation as binding on his/her conscience.

_________________________________________
COMMISSIONER OF OATHS

FULL NAMES: __________________________________________________________________

CAPACITY: ____________________________________________________________________

ADDRESS: _____________________________________________________________________

DECLARATION WHERE THE APPLICANT IS A SOLE PROPRIETOR OR A

PARTNERSHIP

I, ___________________________________________________________ (full names) hereby

declare under oath/affirm as follows:

This statement consisting of _____________ pages, each initialed by me. The content of this
statement is true and correct to the best of my knowledge and belief.

I undertake that, as long as I continue to be ______________________________________ (state

designation) of the institution, I will notify NAMFISA of any material changes to, or affecting the
completeness or accuracy of, the information supplied to NAMFISA in this statement as soon as
possible, but in any event no later than 30 days from the day that the changes come to my attention.

I know and understand the content of this declaration. I do not have objections to taking the prescribed
oath/affirmation. I consider the prescribed oath/affirmation to be binding on my conscience.
6994 Government Gazette 12 September 2019 25

__________________________________
SIGNATURE OF DEPONENT

I hereby declare that the deponent has sworn/affirmed to and signed this statement in my presence at
_____________________ on the ____ day of ____________________ 20 ____ and he/she declared
as follows: that the facts herein contained fall within his or her personal knowledge and that he/she
understands the contents hereof; that he/she has no objection to taking the oath/affirmation; that he/
she regards the oath/affirmation as binding on his/her conscience.

_________________________________________
COMMISSIONER OF OATHS

FULL NAMES ___________________________________________________________________

CAPACITY _____________________________________________________________________

ADDRESS ______________________________________________________________________

Initialling of each page by Commissioner of Oaths and deponent

26 Government Gazette 12 September 2019 6994

Schedule 7

ADDITIONAL MICROLENDING BRANCH POST-APPROVAL FORM

Section A

Registered name:  

NAMFISA Registration No:

 
This section allows you to add details of the new additional microlending branch:
 
Physical Address of branch Address line 1:  
Address line 2:
Address line 3:
Town/City:
Postal Address of branch Address line 1:  
Address line 2:
Address line 3:
Town/City:
 Branch Telephone No  
 Branch Fax No  
 Branch e-mail address  

Basic Office Infrastructure information: If no, kindly add comments

a. Sufficient tables and chairs? Yes: No:  
b. Electronic device with subscription Yes: No:  
to a registered credit bureau?
c. Filing systems? Yes: No:  
d. Reasonable degree of confidentiality Yes: No:  
maintained at office?
 
1. Attachment: Certificate of Fitness and Registration issued by Local Authority where additional
microlending branch is situated:
 
2. Attachment: photos of office set-up:  
 
Section B

1. Full names of branch manager:

2. Identity No:  
2. Personal postal address:
3. Personal residential address:
4. Personal telephone Nos:

Attachment 1: CV
Attachment 2: Certified copy of ID
Attachment 3: Certified copy of
educational qualifications (including
highest school leaving certificate)
6994 Government Gazette 12 September 2019 27

Attachment 4: Certified copy of

Certificate of Conduct
Attachment 5: Completed Natural
Persons Fit and Proper questionnaire
Attachment 6:Proof of relevant
experience

Section C
By signing this document I confirm that all the above information is true and accurate and can be relied on
and that I will disclose all necessary material information that may be required by NAMFISA.

SIGNED ON BEHALF OF THE APPLICANT:
Name:
Capacity:
Signature:
28 Government Gazette 12 September 2019 6994

MICROLENDING ACT, 2018

FIT AND PROPER CRITERIA FOR ANY KEY RESPONSIBLE PERSON

STANDARD ML.S.2

issued by NAMFISA under section 35(1) of the Microlending Act, 2018

1. Definitions

(1) In this Standard, “Act” means the Microlending Act, 2018, including the regulations
made thereunder, and the standards issued by NAMFISA under the Act.

(2) Words and phrases defined in the Act have the same meaning in this Standard,
unless the context indicates otherwise, including, without limitation, the following,
as defined in section 1 of the Act:

(a) branch manager;

(b) credit bureau;

(c) Financial Intelligence Act;

(d) key responsible person;

(e) microlender;

(f) NAMFISA; and

(g) principal officer.

2. Applicability

This Standard is applicable to any key responsible person.

3. Fit and proper criteria for a principal officer

(1) Every microlender registered under the Act is required to appoint a principal officer
in terms of section 14(1) of the Act.

(2) A principal officer appointed in terms of section 14(1) of the Act must -

(a) comply with NAMFISA’s fit and proper requirements for key responsible
persons in terms of Schedule 1 of the Act;

(b) be in possession of a Grade 10 certificate or equivalent qualification and

have at least four years administrative or business experience; or

(c) be in possession of a Grade 12 certificate or equivalent qualification and

have at least two years administrative or business experience; and

(d) be employed at the microlending business on a full-time basis.

(3) In the event that a microlender, after its registration as a microlender, appoints a new
principal officer, the newly appointed principal officer must -
6994 Government Gazette 12 September 2019 29

(a) comply with the provisions of clause 3(2); and

(b) within 30 days of his or her appointment, submit the following documents
to NAMFISA pursuant to section 14(10) of the Act -

(i) a duly completed fit and proper assessment set out under Schedule
1 attached to this Standard;

(ii) a certified copy of his or her Identity Document (ID) or passport;

(iii) a copy of his or her updated Curriculum Vitae (CV), certified copies
of his or her educational qualifications and proof of his or her
relevant experience, including but not limited to reference letters
from previous employers or clients or certificates of service from
previous employers, or in the absence thereof, a declaration under
oath confirming his or her relevant experience; and

(iv) a certified copy of the certificate of conduct/crime clearance

certificate, issued by the principal officer’s local police, and which
was issued no longer than 12 months prior to the date of submission
to NAMFISA.

4. Fit and proper criteria for a branch manager

(1) Every microlender registered under the Act is required to appoint a branch manager
in terms of section 21(4) of the Act.

(2) A branch manager appointed in terms of section 21(4) of the Act must -

(a) comply with NAMFISA’s fit and proper requirements for key responsible
persons in terms of Schedule 1 of the Act;

(b) be in possession of a Grade 10 certificate or equivalent qualification and

have at least two years administrative or business experience; or

(c) be in possession of a Grade 12 certificate or equivalent qualification and

have at least one year administrative or business experience.

(3) Should the microlender be necessitated to, at any time, appoint a new branch
manager, the newly appointed branch manager must -

(a) comply with the provisions of clause 4(2); and

(b) within 30 days of his or her appointment, submit the following documents
to NAMFISA pursuant to section 21(10) of the Act -

(i) a duly completed fit and proper assessment set out under Schedule
1 attached to this Standard;

(ii) a certified copy of his or her Identity Document (ID) or passport;

(iii) a copy of his or her updated Curriculum Vitae (CV), certified copies
of his or her educational qualifications and proof of his or her
relevant experience, including but not limited to reference letters
from previous employers or clients or certificates of service from
30 Government Gazette 12 September 2019 6994

previous employers, or in the absence thereof, a declaration under

oath confirming his or her relevant experience; and

(iv) a certified copy of the certificate of conduct/crime clearance

certificate, issued by the branch manager’s local police, and which
was issued no longer than 12 months prior to the date of submission
to NAMFISA.

5. Fit and proper criteria for directors

A person appointed as a director by a microlender must -

(a) comply with NAMFISA’s fit and proper requirements for key responsible persons in
terms of Schedule 1 of the Act;

(b) complete the fit and proper assessment set out in Schedule 1 attached to this Standard;

(c) be in possession of a Grade 12 certificate or equivalent qualification and have at least

two years business experience;

(d) submit a certified copy of his or her Identity Document (ID) or passport;

(e) submit a copy of his or her Curriculum Vitae (CV), certified copies of his or her
educational qualifications and proof of his or her relevant experience, including but
not limited to reference letters from previous employers or clients or certificates of
service from previous employers, or in the absence thereof, a declaration under oath
confirming his or her relevant experience; and

(f) submit a certified copy of the certificate of conduct/crime clearance certificate,

issued by the director’s local police, and which was issued no longer than 12 months
prior to the date of submission to NAMFISA.

6. Fit and proper criteria for a shareholder, member, owner, legal or natural person with
at least five percent ownership or decision-making role in the microlending business

Any shareholder, member, owner, legal or natural person with at least five percent ownership
or decision-making role in the microlending business must -

(a) comply with NAMFISA’s fit and proper requirements for key responsible persons in
terms of Schedule 1 of the Act;

(b) complete the fit and proper assessment set out in Schedule 1 attached to this Standard;

(c) where applicable, submit a certified copy of his or her Identity Document (ID) or
passport;

(d) where applicable, submit his or her Curriculum Vitae (CV);

(e) where applicable, submit a certified copy of the certificate of conduct/crime clearance
certificate, issued by such person’s local police, and which was issued no longer than
12 months prior to the date of submission to NAMFISA; and

(f) where the key responsible person is a legal person, a certified copy of the
memorandum of association and articles, or other instrument constituting or defining
the constitution of the corporate entity or other foundation documents of the key
responsible person.
6994 Government Gazette 12 September 2019 31

SUPPORTING SCHEDULE

The following supporting schedule is attached to and form part of this Standard:

Schedule 1: Fit and proper assessment

32 Government Gazette 12 September 2019 6994

Schedule 1

FIT AND PROPER ASSESSMENT

SECTION A: PERSONAL INFORMATION – NATURAL PERSON KEY RESPONSIBLE

PERSON

A.1 Full names: __________________________________________________________________

A.2 Previous names: ______________________________________________________________

A.3 Current Nationality: ____________________________________________________________

A.4 Previous Nationality: ___________________________________________________________

A.5 Identification number or Passport number: __________________________________________

A.6 Date of Birth: _________________________________________________________________

A.7 Place of Birth: ________________________________________________________________

A.8 Residential address: ____________________________________________________________

A.9 Business address: ______________________________________________________________

A.10 Telephone number: ___________________________________________________________

A.11 Fax number: _________________________________________________________________

A.12 E-mail address: ______________________________________________________________

A. 13 Mobile number: _____________________________________________________________

A. 14 Occupation: ________________________________________________________________

A. 15 Nature and location of business (where applicable): _________________________________

_______________________________________________________________________________
6994 Government Gazette 12 September 2019 33

SECTION B: HONESTY AND INTEGRITY – NATURAL PERSON KEY RESPONSIBLE

PERSON

Full name(s) of Natural Person Key Responsible Person:

_______________________________________________________________________________

If the answer to any of the questions is yes, provide full details on a separate page and attach certified
documents to the form:

YES NO
Has any adverse finding been made against you within a period of ten years
preceding the date of application in any civil or criminal proceedings by a court
1 of law (whether in Namibia or elsewhere), in which you were found to have
acted fraudulently, dishonestly, unprofessionally, dishonorably or in breach of a
fiduciary duty?
Have you within a period of ten years preceding the date of application been
found guilty by any professional, financial services industry or regulatory
2
body (whether in Namibia or elsewhere), of an act of dishonesty, negligence,
incompetence or mismanagement?
Have you within a period of ten years preceding the date of application been
3 denied membership of any body referred to in question 2 above on account of an
act of dishonesty, negligence, incompetence or mismanagement?
Have you within a period of ten years preceding the date of application been
found guilty by any regulatory or supervisory body (whether in Namibia or
4 elsewhere), or has an authorization to carry on business been refused, suspended
or withdrawn by any such body on account of an act of dishonesty, negligence,
incompetence or mismanagement?
Have you at any time prior to the date of application been disqualified or
prohibited by any court of law (whether in Namibia or elsewhere) from taking
5 part in the management of any corporate entity or other statutorily created,
recognized or regulated body, irrespective whether such disqualification has
since been lifted or not?
Have you been the subject of any investigation or disciplinary proceedings or
has administrative action been taken or administrative penalties been imposed
6
by any regulatory authority, professional or government body or agency, an
exchange or a self-regulatory organisation (whether in Namibia, or elsewhere)?
Have you ever been refused authorization to carry on business by any regulatory
body (whether in Namibia or elsewhere), or has such authorization ever been
7
suspended or revoked by any such body, because of negligence, incompetence
or mismanagement?
Are you subject to an order of a competent court holding you to be mentally unfit
8
or disordered?
Have you within a period of ten years preceding the date of application been
9 removed from or left office on account of misconduct relating to fraud, theft or
the misappropriation of money, whether in Namibia or elsewhere?
Have you within a period of ten years preceding the date of application received
10
a grant of amnesty or free pardon for any offence?

11 Has your estate ever been sequestrated?

Have you ever been convicted of an offence or found to be liable under the
Financial Intelligence Act, 2012 (Act No. 13 of 2012), and/or the Prevention
of Organized Crime Act, 2004 (Act No. 29 of 2004), and/or the Prevention and
12
Combating of Terrorist and Proliferation Activities Act, 2014 (Act No. 4 of
2014) and/or any other similar Acts describing similar offences and/or liability
in any country?
Have you within a period of five years preceding the date of application been
13
adversely listed on a Credit Bureau (whether in Namibia or elsewhere)?
34 Government Gazette 12 September 2019 6994

Have you previously been appointed as a Principal Officer or Director in the

14 financial services industry or as a Branch Manager in the microlending industry?
If yes, provide more information, i.e. duration, which company, etc.
Are you involved in other corporate entities as a Director, Shareholder, Member,
15 Trustee, etc.? If yes, provide more information, i.e. duration, which company,
etc.
Has any corporate entity in respect of which you are or were a Member,
Shareholder, Director, Trustee or officer ever been convicted or an offence or
found to be liable under the Financial Intelligence Act, 2012 (Act No. 13 of
16 2012), and/or the Prevention of Organized Crime Act, 2004 (Act No. 29 of 2004),
and/or the Prevention and Combating of Terrorist and Proliferation Activities
Act, 2014 (Act No. 4 of 2014) and/or any other similar Acts describing similar
offences and/or liability in any country?
Do you have any additional information, which should be brought to NAMFISA’s
17 attention, which may have an impact on the evaluation by NAMFISA of your
good character and integrity?

SECTION C: COMPETENCE – NATURAL PERSON KEY RESPONSIBLE PERSON

Full name(s) of Natural Person Key Responsible Person:

_______________________________________________________________________________

C.1 Training (complete table below):

Qualification Institution Date obtained

C.2 Experience (complete table below):

Relevant employment history and/or experience in the industry: (To be supported with proof of
relevant experience, including but not limited to reference letters from previous employers or clients
or certificates of service from previous employers). Enclose detailed Curriculum Vitae (CV) of the
natural person key responsible person.

Position held Employer Contact Details Period

SECTION D: WHERE THE NATURAL PERSON KEY RESPONSIBLE PERSON IS A PART

OWNER - SOURCE OF FUNDS AND AMOUNT OF CAPITAL:

Full name(s) of Natural Person Key Responsible Person:

_______________________________________________________________________________

D.1 Source of Funds: ______________________________________________________________

D.2 Amount of share capital: ________________________________________________________

NB: Kindly note that all source of funds must be properly and thoroughly supported with
documentary evidence of how the money was earned, i.e. what activities were conducted to
generate the funds.
6994 Government Gazette 12 September 2019 35

DECLARATION BY THE NATURAL PERSON KEY RESPONSIBLE PERSON

I, ___________________________________________________________ (full names) hereby

declare under oath/affirm as follows:

This statement consisting of _____________ pages, each initialed by me. The content of this
statement is true and correct to the best of my knowledge and belief.

I undertake that, as long as I continue to be a key responsible person of ____________________

______________ (name of microlender), I will notify NAMFISA of any material changes to, or
affecting the completeness or accuracy of, the information supplied to NAMFISA in this statement
as soon as possible, but in any event no later than 30 days from the day that the changes come to my
attention.

I know and understand the content of this declaration. I do not have objections to taking the prescribed
oath/affirmation. I consider the prescribed oath/affirmation to be binding on my conscience.

_________________________________________
SIGNATURE OF DEPONENT

I hereby declare that the deponent has sworn to and signed this statement in my presence at
_____________________ on the ____ day of ____________________ 20 ____ and he/she declared
as follows: that the facts herein contained fall within his/her personal knowledge and that he/she
understands the contents hereof; that he/she has no objection to taking the oath/affirmation; that he/
she regards the oath/affirmation as binding on his/her conscience.

_________________________________________
COMMISSIONER OF OATHS

FULL NAMES ___________________________________________________________________

CAPACITY _____________________________________________________________________

ADDRESS ______________________________________________________________________

SECTION E: INFORMATION - LEGAL PERSON KEY RESPONSIBLE PERSON

E.1 Full registered name: ___________________________________________________________

E.2 Previously registered name(s): ____________________________________________________

E.3 Trading name(s): ______________________________________________________________

E.4 Corporate entity/legal person registration No.: _______________________________________

E.5 Country of registration: _________________________________________________________

E.6 If not incorporated in Namibia please provide description of the corporate entity/legal person:

_______________________________________________________________________________

E.7 Income Tax Registration No. and VAT Registration No., if applicable:

_______________________________________________________________________________
36 Government Gazette 12 September 2019 6994

E.8 Financial year end: _____________________________________________________________

E.9 Nature of business: _____________________________________________________________

E.10 Registered address: ___________________________________________________________

E.11 Principal place of business: _____________________________________________________

E.12 Contact person: ______________________________________________________________

E.13 Postal address: _______________________________________________________________

E.14 Telephone No: _______________________________________________________________

E.15 Fax No: ____________________________________________________________________

E.16 Mobile No: __________________________________________________________________

E.17 Is the corporate entity/legal person subject to financial services regulation in a foreign country
or a financial services intermediary?: __________________________________________________

E.18 If yes, which jurisdiction: _______________________________________________________

E.19 Name of foreign regulator(s): ____________________________________________________

SECTION F: HONESTY AND INTEGRITY – LEGAL PERSON KEY RESPONSIBLE

PERSON

Full name(s) of legal person: ________________________________________________________

If the answer to any of the questions is yes, provide full details on a separate page and attach certified
documents to the form:

YES NO
Has any adverse finding been made against the legal person within a period of ten
years preceding the date of application in any civil or criminal proceedings by a
1 court of law (whether in Namibia or elsewhere), in which the legal person has been
found to have acted fraudulently, dishonestly, unprofessionally, dishonorably or
in breach of a fiduciary duty?
Has the legal person within a period of ten years preceding the date of application,
been found guilty by any professional, financial services industry or regulatory
2
body (whether in Namibia or elsewhere), of an act of dishonesty, negligence,
incompetence or mismanagement?
Has the legal person within a period of ten years preceding the date of application,
3 been denied membership of any body referred to in question 2 above on account
of an act of dishonesty, negligence, incompetence or mismanagement?
Has the legal person within a period of ten years preceding the date of application,
been found guilty by any regulatory or supervisory body (whether in Namibia or
4 elsewhere), or has an authorization to carry on business been refused, suspended
or withdrawn by any such body on account of an act of dishonesty, negligence,
incompetence or mismanagement?
Has the legal person at any time prior to the date of application been disqualified
or prohibited by any court of law (whether in Namibia or elsewhere) from taking
5 part in the management of any other corporate entity or other statutorily created,
recognized or regulated body, irrespective whether such disqualification has
since been lifted or not?
6994 Government Gazette 12 September 2019 37

Has the legal person been the subject of any investigation or disciplinary
proceedings or has administrative action been taken or administrative penalties
6 been imposed by any regulatory authority, professional or government body
or agency, an exchange or self-regulatory organisation (whether in Namibia or
elsewhere)?
Has the legal person ever been refused authorization to carry on business by any
regulatory body (whether in Namibia or elsewhere), or has such authorization
7
ever been suspended or revoked by any such body, because of negligence,
incompetence or mismanagement?
Has the legal person ever been placed under judicial management, insolvency,
8
liquidation or any other processes of a similar nature?
Has the legal person ever been convicted of an offence or found to be liable under
the Financial Intelligence Act, 2012 (Act No. 13 of 2012), and/or the Prevention
of Organized Crime Act, 2004 (Act No. 29 of 2004), and/or the Prevention and
9
Combating of Terrorist and Proliferation Activities Act, 2014 (Act No. 4 of 2014)
and/or any other similar Acts describing similar offences and/or liability in any
country?
Does the legal person have any additional information, which should be brought
10 to NAMFISA’s attention, which may have an impact on the evaluation by
NAMFISA of the legal person’s conduct?

SECTION G: SOURCE OF FUNDS AND AMOUNT OF SHARE CAPITAL:

Full name(s) of Legal Person Key Responsible Person: ___________________________________

_______________________________________________________________________________

G.1 Source of Funds: ______________________________________________________________

G.2 Amount of share capital: ________________________________________________________

NB: Kindly note that all source of funds must be properly and thoroughly supported with
documentary evidence of how the money was earned, i.e. what activities were conducted to
generate the funds.

DECLARATION BY APPLICANT WHERE THE KEY RESPONSIBLE PERSON IS A

LEGAL PERSON

I, ___________________________________________________________ (full names) in my

capacity as _____________________________________ of the applicant referred to herein, hereby
declare under oath/affirm as follows:

This statement consisting of _____________ pages, was completed by me. The contents of this
statement are true to the best of my knowledge and belief.

I undertake that, as long as I continue to be a ____________________________ of the entity, I

will notify NAMFISA of any material changes to, or affecting the completeness or accuracy of, the
information supplied to NAMFISA as soon as possible, but in any event no later than 30 days from
the day that the changes come to my attention.

I know and understand the content of this declaration. I do not have objections to taking the prescribed
oath/affirmation. I consider the prescribed oath/affirmation to be binding on my conscience.

____________________________________
SIGNATURE OF DEPONENT
38 Government Gazette 12 September 2019 6994

I hereby declare that the deponent has sworn/affirmed to and signed the declaration in my presence at
_____________________ on the ____ day of ____________________ 20____ and he/she declared
as follows: that the facts herein contained fall within his or her personal knowledge and that he/she
understands the contents hereof; that he/she has no objection to taking the oath/affirmation; that he/
she regards the oath/affirmation as binding on his/her conscience.

_________________________________________
COMMISSIONER OF OATHS

FULL NAMES: __________________________________________________________________

CAPACITY: ____________________________________________________________________

ADDRESS: _____________________________________________________________________
________________