APPLICATION FORMS AND NOTICES (AFN) – MKT3

For DFSA use only

MKT3 Form

Sponsor’s Declaration

For enquiries relating to this form please contact:
Telephone: +971 4 362 1500
E-mail:

Notes for completing this form

  • Defined terms are identified throughout this declaration 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.
  • The DFSA requires the original of the completed sponsor’s declaration. No facsimiles will be accepted. The declaration must be signed and initialled manuallywhere necessary and not mechanically or electronically.
  • This declaration form is in PDF format on the DFSA’s website. Editable Microsoft Word version can be obtained from the DFSA on request.
  • A passport copy of the individual authorised to sign this declaration must be provided with this declaration.

SPONSOR’S DECLARATION ON AN APPLICATION FOR PROSPECTUS APPROVAL

Click here to enter a date.

I Insert full Name, insert full title, of insert name of sponsor, sponsor for the Prospectus Offer made byinsert name of the Issuer, hereby declare that to the best of my knowledge and belief and having made due and careful enquiry, that the Directors of insert name of the Issuer:

(a) have satisfied all applicable conditions and other relevant requirements under the Markets Rules in relation to the Offer of Securities to the Public or admission of Securities to trading on an Authorised Market Institution;

(b) have a reasonable basis on which to make the working capital statement required by the DFSA in accordance with Appendix 1.2.1(1.4) of the Markets Rules of the DFSA Rulebook (MKT) and such statement is properly made and based on reasonable assumptions;

(c) have put in place systems and controls to enable them to comply with the disclosure requirements in accordance with the MKT on the date of the Prospectus Offer and on an on-going basis; and

(d) have put in place systems and controls which provide a reasonable basis for the Directors to make a balanced, comprehensive and understandable assessment, on an on-going basis, as to the financial position and prospects of the Issuer and its group in accordance with Appendix 2.1.1(6.1), (6.2) & (6.3) of the MKT.

I further confirm that:

(a)we have acted with due care and skill in relation to the provision of sponsor services;

(b)we have taken reasonable steps to satisfy ourselves that the Directors of the Issuer understand their responsibilities and obligations under the MKT;

(c)any information or explanation which the DFSA may reasonably require to verify whether the MKT are being, and has been, complied with by insert name of the Issuerhas been provided to the DFSA;

(d)all matters known to us which, in our reasonable opinion, should be taken into account by the DFSA in considering the application for Prospectus approval and admission to the Official List of Securities by insert name of the Issuerhave been disclosed with sufficient prominence in the Prospectus; and

(e) the information given in this form is true and complete and 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;

I confirm that I have the authority to declare and confirm as specified above and sign this declaration form for and on behalf of insert name of sponsor.

Signature of Director/Senior Executive Officer of the sponsor
Date
Name of Director/Senior Executive Officer
Company stamp or seal

Please return the completed form to:

Dubai Financial Services Authority

Markets Department

Level 13, The Gate Building

Dubai International Financial Centre

PO Box 75850

Dubai, UAE

The sponsor is advised to retain a copy of this form and any relevant attachments for record purposes.

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