19. The name and signature of the representative of the Microfinance Institution. 50 Statutory Instruments 30th January, 2006 - Form MF 6 THE BANKING AND FINANCIAL SERVICES (MICROFINANCE) REGULATIONS, 2006 (Regulation 45) BANK OF ZAMBIA VITAL STATISTICS FORM Part A (This Part Applies to Zambian Citizens Only) Name: ................................................................................................................ ................. . Date of birth: ................................................................................ ...................................... . Identity card number: ..................... , .................................................................................... . Residential address: ............................................................... Telephone No ........................ . Business address: ............................................................... Telephone No ............................ . Marital Status: ........................................ ........ No. of children ............................................. . Passport No./NRC No.: ......................... Expiry date (Passport No.lNRC indicated): ............ .. Name of Spouse: ........................................ Identity card No.: ............................................... . Next of kin: ........................................... Name of parents ................................................... .. Part B (This Part Applies to non-Zambian Citizens Only) Name: ..................................................................... Residential address: ............................. . Immigration Permit No: ............................................. Passport No: ............................. : ........ . Expiry date of passport: ...................................... Date of entry into Zambia: ......................... . Work permit No: ..................................... .'.Valid from ..................... to: ................................ . Part B (Applies to both Zambians and non-Zambians) Education Background: ....................................................................................................... . 30th January, 2006 Statuto1y Instruments 5 1 Employment Record:, . . . . . . . . . . . , . . , . , , ..................... , .. , , . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . , . . , .. . ..................................................................................................................... ........................................................... ,, ................................................ , , ....... .. .......................... , .................................................... , ................................... .. ································································································ ····················· ······················································································································ .......... , .................................................... , , .... ............................................... . ························································· ........................................................... . ········································· .................................................................... , ...... . ·········································· .......................................................................... . ·········································· ........................................................................... . Last Employer: ......... . . . . . . . . . . . . . . . . . . . . . . ..................................... . . ............... ...... . . . . . . . . . . . Employer's reference: . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............ . ···················································· ................................................................. . ··························································································"· .. ····················-- ........................................................................................... ........................... .............................................................................. , .................................... .. ····················································································································" ..... .............. .................................................................................................. . ................ -................................................................................................... .. ··················································--· ................................................................ . ..................................................................................................................... ........................................... ......... , ............................ , ................................. .. ····································································· ............................................... . Signature: . . . . . . . . . . . . . . . . . . . . . . . . . . ............................. . ..... . 52 Statutory Instruments 30th January, 2006 SECOND SCHEDULE (Reg11/ations 26, 41 and 46) PART I CAPITAL REQUIREMENTS FOR MICROFINANCE INSTITUTIONS (Regulation 26) Minimum Capital Requirement Deposit Taking MF/ Non DepositTc1king MF! K250 Million K25 Million PART'II PRESCRIBED FEES (Reg11/ation 41 and 46) Deposit-1Clking Micro.finance Institution Non Deposit-Tc1king Micro.finance Institution Licence application fee KS,400,000.00 Annual Licence fee K2,700,000,00 Supervision fee