APPLICATION FORMS AND NOTICES (AFN) – SUP2

Form SUP2

Application for a waiver

Name of Authorised Firm
DFSA Reference number

Purpose of this form

An Authorised Firm wishing to apply for a waiver of a Rule must submit this form.

Contents

This form consists of six sections:

1.  Authorised Firm details

2.  Details of waiver sought

3.  Research and reasons

4.  Publication

5.  Additional information

6.  Declaration and signature

Notes for completing this form

·  Defined terms are identified throughout this form by the capitalisation of the initial letter of a word or phrase and are defined in the Glossary module (GLO) of the DFSA’s Rulebook.

·  Sections 1, 2, 3, 4 and 6 must be completed.

·  Please use section 5 if you wish to provide additional information that may clarify or support your answers in sections 1-4.

·  Questions must be fully answered and the use of abbreviations should be avoided.

·  Answers must be typed and the form must be signed by either the Authorised Firm’s Senior Executive Officer or Compliance Officer.

·  Please ensure any supporting documentation is clearly labelled and securely attached.

·  When completed, submit this application form in line with GEN section 11.2. You may send applications by post or hand delivered and addressed to your usual supervisory contact.

The address for postal submission is:

DUBAI FINANCIAL SERVICES AUTHORITY

AUTHORISATION DEPARTMENT

LEVEL 13, THE GATE

PO BOX 75850

DUBAI, UAE

·  You can inspect published waivers on the DFSA website: www.dfsa.ae

1. AUTHORISED FIRM DETAILS

1.1 Name of Authorised Firm
1.2 DFSA License number
1.3 / Contact person within Authorised Firm
1.4 / Position/title
1.5 / Contact details / Telephone
(incl. area code)
Fax
E-mail

2. DETAILS OF WAIVER SOUGHT

2.1 Are you applying for a variation of an existing waiver? If so, give the waiver number.

2.2  Rulebook reference number of the Rule(s) to which this application relates.

2.3 What is the desired outcome of the proposed Rule waiver?

2.4 Are you applying for the Rule to be waived completely, or for a modification of the Rule? If a modification, provide a draft of the modification sought.

2.5  Detail any special requirements.

3. RESEARCH AND REASONS

3.1 Confirm that you have checked the waivers published by the DFSA for any precedent. If your application is based on precedent, give the previous reference number.

3.2 Give a full and clear explanation of why you want the waiver.

4. PUBLICATION

4.1 Are you content for the waiver to be published? If NO, state your reasons.

5. ADDITIONAL INFORMATION

Please use this section to provide any information that may clarify or support your answers in sections

1 – 4.

Question Details

6. DECLARATION

Declaration by Authorised Firm

1.  I declare that, to the best of my knowledge and belief, having made due enquiry, the information given in this form is complete and correct. I understand that it is an offence under Article 66 of the Regulatory Law 2004 to provide to the DFSA any information which is false, misleading or deceptive or to conceal information where the concealment of such information is likely to mislead or deceive the DFSA.

2.  I confirm that I have the authority to make this application, to declare as specified above and sign this form for the Authorised Firm.

Print Name of Senior Executive Officer or Compliance Officer*

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Signature of Senior Executive Officer or Compliance Officer* Date

*Delete as appropriate

9 of 9 SUP2/VER3/04-11