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STATISTICAL INFORMATION REPORTING FORM CENTRALE BANK VAN CURAÇAO

TRUST SERVICE PROVIDERS EN SINT MAARTEN (CENTRAL BANK)

Investment Institutions & Trust

Supervision Department

Name of Trust Service Provider (“TSP”): …………….…………………………

Reporting calendar year: ………………………………………

___________________________________________________________________________________

Part I: Please provide us with the information requested in the table below concerning the international companies (“I.C.”)[1] serviced by your institution or your person (for trust service providers being natural persons). The reporting cut-off date to be used is December 31 of each year.

| |(1) |(2) |(3) |(4) |(5) |(6) |(7) |

|Legal Form |Number of I.C. |Number of I.C. |Number of I.C. |Number of |Number of I.C. with statutory |Number of I.C. |Number of |

| |at the beginning|established during|liquidated |resignations during|seat transfers during the year,|received from (or |I.C. at the |

| |of the year |the year |during the year |the year |specified by country of |transferred to) |end of the year |

| | | | | |re-domiciliation |other local TSPs |(1)+(2)-(3)-(4)-(5)+|

| | | | | | |during the year |or -(6) |

| | |

|Number of non-resident employees | |

|Total number of employees | |

___________________________________________________________________________________

Date: ………………………………………….

Signature (of managing director) of trust service provider: ……………………………………………

Name of managing director signing on behalf of trust service provider: ……………………………..

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[1] International company: a legal person which has its registered office or its actual place of business in Curaçao or Sint Maarten and which has been granted dispensation from the provisions of articles 10 - 16 of the Foreign Exchange Regulation of Curaçao and Sint Maarten (2010).

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