FICA Questionnaire - Juristic Person - Waldick Inc. Attorneys

082 721 3276
herman@waldickinc.co.za

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FICA Questionnaire - Juristic Person

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FICA Questionnaire
Juristic Person

Page 1 of 10

Please complete all required fields!

All documents must be completed in full, and no funds will be invested or paid without the completed and verification documents.

Verification and supporting documents to be provided as set out in the guidelines below.

Hover of the icon to see more details about the field.

Juristic Person (Trust/Partnership/Company)

Full Name of Legal Entity *

Please complete field

Trading Name (If Different)*

Please complete field

Registration Number / CC Number / Trust Number*

Please complete field

Date of Registration*

Please select a Date

Nature of client’s business / principal activity*

Please complete field

Contact Number*

Please complete field

Registered Business Address *

Please complete the field

Postal Address*

Please complete the field

Physical Address*

Please complete the field

Email Address of Contact Person*

Please complete field, valid email address

Contact Number of Contact Person*

Please complete the field

Income Tax Reference Number*

Please complete the field

VAT Number*

Please complete the field

Accountant Details*

Please complete the field

Legal Representative

Invalid Input

Is the entity incorporated in South Africa *

Is the entity incorporated in South Africa

Yes

No

Please select and option

Financial Information

Bank Account Details

From which payment of any cash amount is made to the Agency or Waldick Inc.
Into which payment of proceeds are to be made
Transactional bank account for purposes of any matter with Waldick Inc.

Account Holder*

Please complete field

Bank*

Please complete field

Branch*

Please complete field

Account Number*

Please complete field

NB Banking details will be confirmed again for purposes of payments to be received by the client.

Ownership and Control

List all individuals who directly or indirectly own or control 25% or more of the membership interest or shareholder voting rights in the juristic entity.

Number of Individuals*

Please select an option

Individual 01:

Full Name*

Please complete the field

ID/Passport Number*

Please complete the field

Percentage Ownership*

Please complete the field

Residential Address*

Please complete the field

Contact Number*

Please complete the field

Individual 02:

Full Name*

Please complete the field

ID/Passport Number*

Please complete the field

Percentage Ownership*

Please complete the field

Residential Address*

Please complete the field

Contact Number*

Please complete the field

Individual 03:

Full Name*

Please complete the field

ID/Passport Number*

Please complete the field

Percentage Ownership*

Please complete the field

Residential Address*

Please complete the field

Contact Number*

Please complete the field

Individual 04:

Full Name*

Please complete the field

ID/Passport Number*

Please complete the field

Percentage Ownership*

Please complete the field

Residential Address*

Please complete the field

Contact Number*

Please complete the field

Individual 05:

Full Name*

Please complete the field

ID/Passport Number*

Please complete the field

Percentage Ownership*

Please complete the field

Residential Address*

Please complete the field

Contact Number*

Please complete the field

Shareholders/Members

Indicate the number of shareholders or members*

Indicate the number of shareholders or members

1-5

6-10

11-100

More than 100

Please select an option

Directors

Indicate the number of directors*

Indicate the number of directors

1-5

6-10

11-20

21-30

More than 30

Please select an option

Ownership and Control

If no individual owns 25% or more, complete section below list all directors / members / trustees of the entity.

Number of Individuals*

Please select an option

Individual 01:

Full Name*

Please complete the field

ID/Passport Number*

Please complete the field

Percentage Ownership*

Please complete the field

Residential Address*

Please complete the field

Contact Number*

Please complete the field

Individual 02:

Full Name*

Please complete the field

ID/Passport Number*

Please complete the field

Percentage Ownership*

Please complete the field

Residential Address*

Please complete the field

Contact Number*

Please complete the field

Individual 03:

Full Name*

Please complete the field

ID/Passport Number*

Please complete the field

Percentage Ownership*

Please complete the field

Residential Address*

Please complete the field

Contact Number*

Please complete the field

Individual 04:

Full Name*

Please complete the field

ID/Passport Number*

Please complete the field

Percentage Ownership*

Please complete the field

Residential Address*

Please complete the field

Contact Number*

Please complete the field

Individual 05:

Full Name*

Please complete the field

ID/Passport Number*

Please complete the field

Percentage Ownership*

Please complete the field

Residential Address*

Please complete the field

Contact Number*

Please complete the field

Beneficial Owners

Does the entity have any beneficial owners who are natural persons?*

Does the entity have any beneficial owners who are natural persons?

Yes

No

Please select an option

If yes, provide full details as per Shareholders & Members section.

Number of Individuals*

Please select an option

Individual 01:

Full Name*

Please complete the field

ID/Passport Number*

Please complete the field

Percentage Ownership*

Please complete the field

Residential Address*

Please complete the field

Contact Number*

Please complete the field

Individual 02:

Full Name*

Please complete the field

ID/Passport Number*

Please complete the field

Percentage Ownership*

Please complete the field

Residential Address*

Please complete the field

Contact Number*

Please complete the field

Individual 03:

Full Name*

Please complete the field

ID/Passport Number*

Please complete the field

Percentage Ownership*

Please complete the field

Residential Address*

Please complete the field

Contact Number*

Please complete the field

Individual 04:

Full Name*

Please complete the field

ID/Passport Number*

Please complete the field

Percentage Ownership*

Please complete the field

Residential Address*

Please complete the field

Contact Number*

Please complete the field

Individual 05:

Full Name*

Please complete the field

ID/Passport Number*

Please complete the field

Percentage Ownership*

Please complete the field

Residential Address*

Please complete the field

Contact Number*

Please complete the field

Additional Information

Industry (SIC) *

Please complete the field

In which country do you trade in*

In which country do you trade in

South Africa

Other

Please select an option

If other, specify*

Please complete the field

In which jurisdiction is your main trade*

In which jurisdiction is your main trade

South Africa

Other

Please select an option

If other, specify*

Please complete the field

Method of Payment for this Transaction (SOF) *

Method of Payment for this Transaction (SOF) <i class="fa-solid fa-circle-info"></i>

Cash

Cheque

EFT

Bank Guarantee

Please select an option

Nature of Transactions to be conducted*

Please complete the field

Expected Monthly Turnover*

Please complete the field

Source of Fund*

Please complete the field

Documents

Certified Copies Required

Certificate of Incorporation / Registration*

Please select a file

MOI / Founding Statement*

Please select a file

Identity documents of directors / members / beneficial owners*

Please select a file

Proof of residential addresses for directors / members / beneficial owners*

Please select a file

Proof of bank account / financial reference (if applicable)

Please select a file

Compliance Declaration, Sign and Submit

Waldick Inc, s a firm of attorneys, has the privilege of confidentiality in accordance with the Protection of Personal Information Act 4 of 2013 (“POPI”) concerning its clients. By signing below, I consent to the processing of the information contained herein as required under Section 11(1)(a) of POPI. The staff and finance department of WJVR Inc are authorised to access the Company’s details provided herein for the purpose of attending to the Company’s matters and any ancillary matters related thereto. WJVR Inc is further authorised to disclose the Company’s personal information to:

The South African Revenue Service;
Relevant municipal authorities; and
Any litigation attorney mandated to assist with the enforcement or cancellation of the transaction, or with a claim for damages, or any action or application proceedings related to the transaction, solely for the purposes of this transaction.

In addition to compliance with POPI, WJVR Inc will store the Company’s personal information in accordance with the requirements specified by the Legal Practice Council from time to time.

I hereby declare that the information provided is true and correct.*

Sign Above

please sign

Name*

Please complete the field

Position / Role*

Please complete the field

Signed at Place*

Please complete the field

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Waldick Inc. Attorneys

Herman Waldick

Director

Herman started his illustrious law career at Old Mutual and worked as a manager for 10 years. He obtained his LLB degree from the University of South Africa. He was admitted as an attorney in 1999 and appointed as Director at Duvenage Incorporated in Kwazulu-Natal in January 2010. He holds a Master’s Degree in International Business Law from the University of Leiden in the Netherlands. He became a partner during 2008 at Weyer Waldick & Willemse Attorneys. In 2015 Weyer Waldick & Willemse Attorneys and JVR attorneys merged and Herman is one of the founding partners of Waldick Jansen van Rensburg Incorporated. Herman successfully attended the Judicial Training course during 2016.

Herman specialises in the following fields:

Commercial & Corporate Law and High Court Litigation relating to Commercial & Corporate Law
Advises clients in the National Transport Sector, Construction, Intelligence, Information Technology, Trademark and Copyright infringement, Tax litigation and Banking

Tel: 012 643 0004

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Anoeschka Du Plessis

Senior Associate

Anoeschka obtained her LLB Degree from the University of the North West in 2011 and her LLM (Environmental Law) Degree from the University of the North West in 2012. She was admitted as an Attorney of the High Court on 7 July 2014 with right of appearance in the High Court.

Anoeschka has experience in inter alia the following fields of law:

High Court Litigation
Magistrate Court Litigation
Personal Injury Law
Family Law
Debt Collection

Tel: 012 643 0004

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Henry Jacobs

Associate

Henry obtained his Bcom Law Degree in 2014, his LLB Degree in 2016 and LLM Degree in Estate Law in 2017 all from the University of Potchefstroom. Admitted as a Legal Practioner practising as an Attorney of the High Court during October 2019.

Henry specialises in the following fields:

Estate Law
Labour Law

Tel: 012 643 0004

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Stephanie Oosthuizen

Associate Attorney

Stephanie obtained her BCom Law degree from the North West University in 2020 and her LLB degree from the North West University in 2022. She is also a member of the Golden Key Society.

Tel: 012 643 0004

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Sean Riekert

Candidate Attorney

Sean obtained his LLB degree from the University of the Free State in 2020.

Tel: 012 643 0004

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Ashika Kidsingh

Senior Paralegal Administrator

Tel: 012 643 0004

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Riaan Waldick

HR Manager

Tel: 012 643 0004

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Quintin van Pletzen

Candidate Attorney

In 2009, Quintin graduated with an LLB Law degree from the University of Pretoria. He gained experience as a Legal Advisor in the Private Sector for several years, and since 2017, he has worked as an Industrial Relations Specialist and Labour consultant across various industries such as hospitality, motor, construction, and freight sectors. Quintin has successfully represented several companies at the CCMA.

In 2024, Quintin joined Waldick Inc. Attorneys as a Candidate Attorney, adding to the firm's already strong reputation.

Tel: 012 643 0004

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Melinda Mynhardt

Associate Attorney

Melinda obtained her BA Law degree from the University of Pretoria in 2020 and her LLB degree from the University of Pretoria in 2022.

Tel: 012 643 0004

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Ane Pretorius

Junior Associate Attorney

Ané obtained her BA Law degree from North West University in 2021 and her LLB degree from North West University in 2023.

Tel: 012 643 0004

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