SHASHANK NATHANI

NAME: ________________________
Background information Declaration Form

The questions below relate to both the UK and Overseas locations. If you respond 'yes' to any of the questions please provide full details on a
separate sheet and attach to this application
information

Overseas Residence or Employment

Have you ever lived or worked in a country other than the country in which you are applying to work for CME Group? [ ] yes [ ] no
If yes, please list each country along with the dates which you lived and/or worked:

Criminal and civil record

Have you ever been convicted of a criminal offence? (This is subject to your rights in relation to spent convictions unless excepted) [ ] yes [ ] no

Are there any criminal or disciplinary charges pending against you? [ ] yes [ ] no

Are you currently engaged in or have you ever been involved in litigation with your current or former employer, which has
resulted or may result in action in a court or tribunal or a settlement by negotiation, arbitration, mediation or alternative dispute [ ] yes [ ] no
resolution procedure?
Have you ever been the subject of a civil action that resulted in a finding e.g. A fine or judgment, against you in any country in the World?
[ ] yes [ ] no
Have you ever had a judgement debt (including a county court judgement) made under a court order i n a n y c o u n t r y i n t h e
[ ] yes [ ] no
W o r l d or an individual voluntary arrangement (or in Scotland, a trust deed) or equivalent with creditors?

Have you ever entered into a deed of arrangement with creditors? [ ] yes [ ] no

Have you ever failed to satisfy any such judgement debts within one year of the making of the order? [ ] yes [ ] no

Have you ever been declared bankrupt or had your estate sequestrated, been the subject of such proceedings, or is any such action
[ ] yes [ ] no
pending?

Other actions and disqualifications

Have you ever been or are you currently the subject of any investigation or disciplinary procedure in relation to your business or
professional activities (including conduct when running a business or behaviour/acts done in previous employment)? [ ] yes [ ] no

Have you ever been criticised, censured or disciplined by any organisation or body in relation to your business or professional
[ ] yes [ ] no
activities (including conduct when running a business or behaviour/acts done in previous employment)?

Have you ever been refused or had revoked membership of any professional body or organisation of which you have been, or applied to
[ ] yes [ ] no
be, a member?
Have you ever been disqualified by a court from acting as a director of a company or from being concerned with the management of
[ ] yes [ ] no
any company, partnership or unincorporated body?

Business Interests

Are you, or have you ever been, an officer (either as director or company secretary) or a partner of any company other than in a capacity
[ ] yes [ ] no
specified in the employment history section?

Do you own more than 5% of any corporate body? [ ] yes [ ] no

Are you currently engaged in any other outside business activity or employment not stated elsewhere in this form? [ ] yes [ ] no

Do you, or any of your immediate relatives, have a business interest, employment obligations or are there any other situations that
would conflict, or appear to conflict, with the employment for which you are applying? (Immediate relatives include husband, wife,
[ ] yes [ ] no
registered civil partner, partner living with you, children, brothers, sisters, cousins, aunts, uncles, parents, grandparents, and any such
relatives by marriage or registered civil partnership.)

[ ] I have supplied further information relating to this page at the end of this application

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 Regulated Role

The need for you to fulfil such a role will have been confirmed to you in your job description/scope of work
Questions in this section are mandatory only for applicants entering regulated positions. If this is not the case please leave this section blank and proceed
to the next section.

Have you ever been convicted of any offence in any country in which you have resided, worked or visited, whether
or not "spent" ( p u r s u a n t t o a p p l i c a b l e l a w s o f s u c h c o u n t r y ) , involving fraud, theft, false
accounting, serious tax offences, corruption offences, offences against public justice (e.g. Perjury), other dishonesty, or
an offence relating to companies, building societies, industrial and provident societies, credit unions, friendly
societies, insurance, banking or other financial services, insolvency, consumer credit, consumer protection, money [ ] yes [ ] no
laundering, market manipulation or insider dealing?

Have you any outstanding financial obligations arising from regulated activities, which you have conducted in the
past, whether in the country in which you are applying to work or elsewhere?
(In the case of advisers, this will include any outstanding liabilities arising from commissions paid for the sale of
[ ] yes [ ] no
packaged products that have lapsed.)

Have you ever been found guilty of conducting any unauthorised regulated activities or been investigated for possible
conduct of unauthorised regulated activities? [ ] yes [ ] no

Has any company, partnership or unincorporated association of which you are or have been a controller, director,
senior manager, partner or company secretary, in the location of the CME Group entity for which you are applying to
work or elsewhere, at any time during your involvement or within one year of such an involvement:

A) been put into liquidation, wound up, ceased trading, had a receiver or administrator appointed or entered
into any voluntary arrangements with its creditors? [ ] yes [ ] no

B) been adjudged by a court liable for any fraud, misfeasance, wrongful trading or other misconduct? [ ] yes [ ] no

C) been investigated or been involved in an investigation by an inspector appointed under the Companies Act
or any other legislation, or required to produce documents to the Secretary of State or any other [ ] yes [ ] no
authority, under any such legislation?

D) been convicted of any criminal offence, censured, disciplined or publicly criticised, by any inquiry, by the
takeover panel or any governmental or statutory authority or any other regulatory body? [ ] yes [ ] no

[ ] I have supplied further information relating to this page at the end of this application

Confidential 01/12/2015 Page 2