Please Read the Notes Included at the End of the Form Before Completing the Form

/ Aircraft Operator Holding Account
Application Form / CCP-ETS-F05.03
Date of version creation:
10/09/2012

This application form shall be used to provide information required for the opening of an Aircraft Operator Holding Account pursuant to Directive 2003/87/EC, as amended, and applicable Maltese legislation. An application will only be accepted if a valid monitoring plan, approved by the competent authority of Malta pursuant to local legislation transposing Directive 2003/87/EC, is available.

Please read the notes included at the end of the form before completing the form.

For each account requested, a separate, duly completed form shall be submitted.

The duly completed form, together with electronic copies of additional documentation required, shall be submitted to the Malta National Administrator at: .

Hard copies of the additional documentation required shall also be submitted by post to the attention of: The National Registry Administrator at:

Malta Resources Authority,

Climate Change & Policy Unit,

Millennia, 2nd Floor,

Aldo Moro Road,

Marsa MRS 9065, Malta.

In case of any queries about the completion of this form, please contact the National Registry Administrator at the aforementioned e-mail address.

Aircraft Operator Holding Account
Application Details / For Official Use
Account Holder
(please refer to note 2) / Visibility in UR website
(note 6)
Name / YES / Account ID
Address Line 1 / YES / Account Holder ID
Address Line 2 / YES / Commitment period
Region/state / YES / Account opening date
Postcode / YES / Account Closing date
City / YES
Country / YES
Telephone No. 1. / NO
Telephone No. 2. / NO
E-mail Address / NO
Company Reg. No. / YES
VAT Reg. No. with country code (if applicable) / NO
Account Identifier / NO
Authorised Representative 1
(please refer to note 3) / Visibility in UR website
(note 6)
URID[†] / DEFAULTYESNO / Person ID
Last Name / DEFAULTYESNO
Letter of nomination
First Name / DEFAULTYESNO
Certified copy of ID card/ passport
Title / DEFAULTYESNO
Certified evidence of residency
Job Title / DEFAULTYESNO
Copy of criminal record
Company name / DEFAULTYESNO
Company dept. / DEFAULTYESNO
Address Line 1 / DEFAULTYESNO
Address Line 2 / DEFAULTYESNO
Region/state / DEFAULTYESNO
Postcode / DEFAULTYESNO
City / DEFAULTYESNO
Country / DEFAULTYESNO
Telephone No / DEFAULTYESNO
Mobile Phone No / DEFAULTYESNO
Fax Number / DEFAULTYESNO
E-mail Address / NO
Date of birth / NO
Place of birth / NO
Country of birth / NO
Authorised Representative 2
(please refer to note 3) / Visibility in UR website
(note 6)
URID[†] / DEFAULTYESNO / Person ID
Last Name / DEFAULTYESNO
Letter of nomination
First Name / DEFAULTYESNO
Certified copy of ID card/ passport
Title / DEFAULTYESNO
Certified evidence of residency
Job Title / DEFAULTYESNO
Copy of criminal record
Company name / DEFAULTYESNO
Company dept. / DEFAULTYESNO
Address Line 1 / DEFAULTYESNO
Address Line 2 / DEFAULTYESNO
Region/state / DEFAULTYESNO
Postcode / DEFAULTYESNO
City / DEFAULTYESNO
Country / DEFAULTYESNO
Telephone No / DEFAULTYESNO
Mobile Phone No / DEFAULTYESNO
Fax Number / DEFAULTYESNO
E-mail Address / NO
Date of birth / NO
Place of birth / NO
Country of birth / NO
Additional Authorised Representative
(please refer to note 4) / Visibility in UR website
(note 6)
URID[†] / DEFAULTYESNO / Person ID
Last Name / DEFAULTYESNO
Letter of nomination
First Name / DEFAULTYESNO
Certified copy of ID card/ passport
Title / DEFAULTYESNO
Certified evidence of residency
Job Title / DEFAULTYESNO
Copy of criminal record
Company name / DEFAULTYESNO
Company dept. / DEFAULTYESNO
Address Line 1 / DEFAULTYESNO
Address Line 2 / DEFAULTYESNO
Region/state / DEFAULTYESNO
Postcode / DEFAULTYESNO
City / DEFAULTYESNO
Country / DEFAULTYESNO
Telephone No / DEFAULTYESNO
Mobile Phone No / DEFAULTYESNO
Fax Number / DEFAULTYESNO
E-mail Address / NO
Date of birth / NO
Place of birth / NO
Country of birth / NO
Authorised Representative with View only access
(please refer to note 5) / Visibility in UR website
(note 6)
URID[†] / DEFAULTYESNO / Person ID
Last Name / DEFAULTYESNO
Letter of nomination
First Name / DEFAULTYESNO
Certified copy of ID card/ passport
Title / DEFAULTYESNO
Certified evidence of residency
Job Title / DEFAULTYESNO
Copy of criminal record
Company name / DEFAULTYESNO
Company dept. / DEFAULTYESNO
Address Line 1 / DEFAULTYESNO
Address Line 2 / DEFAULTYESNO
Region/state / DEFAULTYESNO
Postcode / DEFAULTYESNO
City / DEFAULTYESNO
Country / DEFAULTYESNO
Telephone No / DEFAULTYESNO
Mobile Phone No / DEFAULTYESNO
Fax Number / DEFAULTYESNO
E-mail Address / NO
Date of birth / NO
Place of birth / NO
Country of birth / NO

Other documents required for a request to open an Aircraft Operator Holding Account:

The following documents shall be submitted (electronically together with the completed form and hard copies by post) to the National Administrator:

1. A signed statement from the account holder indicating that it wishes to nominate a particular person as authorised representative or additional authorised representative or authorized representative with view only access, confirming that the authorised representative has the right to initiate or that the additional authorised representative has the right to approve transactions on behalf of the account holder and indicating limitations to that right. (To ensure the full functionality of the account the Registry Administrator the nomination of at least two (2) authorised representatives and one (1) additional authorised representative would be required.)

2. Evidence to support the identity of the nominee, which may be a copy of one of the following:

a. An identity card issued by a State that is a member of the European Economic Area or the Organisation for Economic Cooperation and Development;

b. A valid passport.

3. Evidence to support the address of the permanent residence of the nominee, which may be a copy of one of the following:

a. the identity document submitted under point 2. above, if it contains the address of the permanent residence;

b. any other government issued identity document that contains the address of permanent residence;

c. if the country of permanent residence does not issue identity documents that contain the address of permanent residence, a statement from the local authorities confirming the nominee’s permanent residence;

d. any other document that is customarily accepted in the Republic of Malta as evidence of the permanent residence of the nominee.

4. Criminal record of the nominee.

The above listed documents should be submitted for each person nominated by the account holder.

Any copy of a document submitted as evidence under points 2. to 4. above shall be certified (or legalized in the case of documents issued outside Malta) as a true copy:

° in the case of Maltese residents, by a Malta registered lawyer, notary, bank manager or chartered accountant;

° in the case of non-Maltese residents, by an embassy, high commission or consulate representing the country of issue in Malta;

° in the case of Maltese or non-Maltese citizens not resident in Malta, by a lawyer, notary, bank manager or chartered accountant registered in the country of residence.

All documents submitted shall either be in Maltese or English.

The National Administrator reserves the right to request any additional information or documentation it deems necessary for the processing of this application.

Notes on completing the application form:

Note 1: All fields (except the fields shaded in grey) shall be filled in. Fields for which no information can be provided shall be completed using “n/a”. Incomplete, out of date or otherwise unclear, inaccurate or false information will result in the Registry Administrator rejecting the application.

Note 2: The aircraft operator shall be given as the “Account holder”. The name recorded for the account holder shall be identical to the name in the monitoring plan.

Note 3: An “authorised representative” is a natural person authorised to initiate transactions and other processes on behalf of the account holder. For each account held in the registry system, the account holder shall appoint at least two authorised representatives. Authorised representatives must be over 18 years of age and for a single account must be different persons. The same person can be an authorised representative or an additional authorised representative on other accounts. If more than two authorised representative are to be nominated, fill in further copies of the relevant table.

Note 4: An “additional authorised representative” is a natural person authorised to approve the initiation of a transaction, in addition to the approval of an authorised representative. The approval of an additional authorised representative is required in order to initiate a transaction. Additional authorised representatives must be 18 years of age and must be a different person from those nominated as authorized representatives for the account. An additional authorised representative may be an authorized representative or an additional authorised representative on more than one account. If more than one additional authorised representative is to be nominated, fill in further copies of the relevant table.

Note 5: The account holder may nominate a number of “authorised representatives with view only access” to the account. If more than one authorised representative with view only access is to be nominated, fill in further copies of the relevant table. There is no minimum number of authorised representatives with view only access.

Note 6: In a number of instances, items are only displayed if the account holder requests them to be made public in accordance with Article 83 of Regulation (EU) No 920/2010 and (EU) No 1193/2011. Please indicate preference accordingly in the box provided, except where mandatory display provisions are already set (grey shaded boxes).

Data Protection Clause:

In terms of the Data Protection Act (Chapter 440 of the Laws of Malta), the National Registry Administrator will process any personal and/or sensitive data provided in this application or subsequently supplied by yourself to the Authority, whether orally or in writing, for all or any of the following:

o the proper processing of your application, as submitted;

o preventing, detecting and/or prosecuting fraud and any other criminal activity which the National Registry Administrator is bound to report and/or act upon whilst meeting any other specific legal or regulatory obligations;

o establishing, exercising or defending any legal action;

o internal management, research and statistics, systems administration, the development and improvement of our services;

o the protection and promotion of legitimate interests of the National Registry Administrator and the proper conduct of the Administrator’s obligations arsing under any law or statutory instrument;

o to make public the necessary information as specified in the relevant law and/or instrument.

Relevant data will be disclosed or shared as appropriate with employees of the National Registry Administrator if pertinent to any of the purposes listed above. Data may also be transmitted to third parties, in whole or in part, where required or allowed by law.

You have the right to require that the Administrator provides you with access to your personal data as well as the right to rectify, or, in appropriate circumstances, erase or edit any inaccurate, incomplete or immaterial personal data which is being processed. You are kindly requested to inform the Administrator of any changes relating to your personal data held by the Administrator.

Notification of fees:

The submission if this application shall be subject to the payment of any fee as provided for by law.

Declaration by the Applicant:

I, the undersigned, hereby confirm that the information contained in this application, including documents submitted with this application, is true and correct and that it represents accurately the information being requested.

I undertake to inform the National Registry Administrator of any changes in the information contained in this application and documentation submitted with the application that may occur from time to time. I also undertake to provide the Administrator any other information that it may request from time to time.

I understand that the National Registry Administrator may carry out the necessary investigations in order to verify this information. I give my consent to the National Registry Administrator to retrieve personal data about me or about any other person whose information is submitted in this application, from any other Government department, public body, institution or authority as may be required in order to process this application.

I also give my consent to the National Registry Administrator to transmit personal data or other type of information submitted in and with this application to third parties, in whole or in part, where required or allowed by law.

I understand that the opening of the account in respect of which this application is being submitted and/or the granting of any authorisation in the course of the processing of this application shall automatically subject me, and any other person to whom an authorisation is granted in respect of the account opened, to any conditions and requirements as laid down by law and/or as may be established by the National Registry Administrator.

______

(Signature of the applicant)

______

(Full name of the signatory)

______

(Title or position of signatory)

____/____/______

(Date)

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[†] This number is assigned following the registration of a user online, please follow provided instructions.