Please Answer the Following Special Questions:
1) Civil, Criminal Litigation and Regulatory Matters:
a) Have you, your spouse, or any business concern you ever controlled, were employed by, served as an officer or director of, or had an ownership interest in, ever been arrested or charged with any crime or offense (other than minor traffic violations)? If yes, provide the following information with regard to any indictment, information, accusation, summons, complaint, arrest or conviction below.
b) Have you, your spouse, or any business concern you ever controlled, were employed by, served as an officer or director of, or had an ownership interest in, been a plaintiff or defendant in any civil matter in a court of law (including debt collection matters or bankruptcy proceedings) or been the subject of a judgment? If yes, provide the details below;
c) Has a bankruptcy petition ever been filed for you, your spouse, or any business concern you ever controlled, were employed by, served as an officer or director of, or had an ownership interest in? If yes, provide the details below, including the name of the petitioner, the date of the petition and where that petition (jurisdiction) was filed;
d) Have you ever been involved with non-routine governmental inquiries, investigations, criminal proceedings, regulatory or enforcement actions in any country? If so, please explain in detail, providing all relevant dates and a description of the reasons for the investigation or proceeding, the conduct alleged, the names and addresses of the persons involved, the name and nationality of the investigating or law enforcement entity, the result of the investigation or proceeding, including any penalties imposed, any ongoing legal disabilities imposed, and any other relevant information (use additional sheets as necessary);
2) U.S. Foreign Corrupt Practices Act and Local Anti-Corruption Laws:
a) Are you aware of the requirements of the U.S. Foreign Corrupt Practices Act and int'l or local anti-bribery laws?
b) Have you ever offered, promised, or received requests for payments of any kind, gifts, or unreasonable entertainment of or from government officials or employees? If yes, please describe the circumstances of the offer, promise or request and how you responded to it.
c) Have you ever been involved in a violation (either alleged, charged, investigated or indicted) of the U.S. Foreign Corrupt Practices Act, any national anti-bribery law or been investigated and/or debarred by the World Bank or government entity? If yes, explain.
d) Please indicate if you or any of your immediate family can be categorized as one or more of the following (Immediate family) means parents, brothers, sisters, children and each of their spouses: a current or former official or employee of a national, provincial or local government or government entity; a current or former official of a political party; a current or former candidate for public office; a current or former employee, director or manager of any state-controlled or state-owned enterprise. (State-controlled and state-owned enterprises include any business that is owned or controlled by any national, provincial or local government.); a current or former employee or official of a public international organization, such as the World Bank, the Int'l Monetary Fund, the United Nations, the Asian Development Bank and the European Union; or a current or former official with any consulting, ceremonial or titular positions for any government entity. If yes, please provide the name of the person holding the position and dates and position held.
e) Have you, any business concern you ever controlled, or directors or shareholders of any business concerns you controlled contributed to the campaign of a political candidate? If so, please name the candidate, the amount contributed and the dates of all contributions made within the past 10 years.
f) Please list any other background information that might indicate a relationship with or connection (present and past) to a government or state owned entity, political entity or int'l organization about which you feel we should be aware.
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