Universal Application form for Financial Services authorisation
Universal Application Form
Body Corporate Questionnaire
Notes on Completion
This form should only be completed where;
- a controller or shareholder
- a director
- a manager, or
- a partner
of the applicant firm is itself a body corporate.
NB: The term “Controller” is used throughout this form in respect of any or all of the above.
Name of Firm to which this form applies
Date Received
FSC Use Only / Data inputted by / Verified byRequested by :
Date: / Date Requested / Date Completed
Other Regulator(s) / No Yes
Referee(s) / No Yes
Previous Employer(s) / No Yes
Open Source checks / No Yes
Professional Bodies / No Yes
GFIU / No Yes
Other :
NOTE: All sections must be completed on a "stand-alone" basis which can be supplemented by (but not replaced with) cross references to additional documents. In these cases, the relevant document, page and paragraph number should be clearly indicated in the appropriate section of the form.
Date of Revision: 1 Dec 2014About the Body Corporate
2.1 Name of Body Corporate (Corporate)
2.2 Has the corporate been known by any other names, does it have use over trading names or does it intend to use any trading names?
No
YesPlease give details
Name / Date name is effectivedd/mm/yy
dd/mm/yy
dd/mm/yy
dd/mm/yy
2.3Principal place of business of corporate
AddressPhone number
Fax number
Email address
2.4 Registered office address (if applicable)
Not applicable
Tick if same as 2.3
Address2.5 Head office address (if applicable)
Not applicable
Tick if same as 2.3
Tick if same as 2.4
Address2.6 Address in Gibraltar for the service of any notice or other document on the
corporate.
Tick if same as 2.3
Tick if same as 2.4
Tick if same as 2.5
AddressDetails of person upon whom notices can be served.
TitleFirst names
Surname
Job title
Phone number
Fax number
Email address
2.7 Website Address
About the legal status of the corporate
2.8 Legal status of the applicant
Public limited company
Private limited company
Other
2.9 Date of incorporation or formation
DayMonth
Year
2.10 Place of incorporation or formation
Town/cityCountry
2.11 Registered number (if any)
2.12 Attach a copy of the Certificate of Incorporation of the Applicant (if any)
Certificate of Incorporation of the Applicantattached to application.
Memorandum & Articles of Association
2.13 Does the Memorandum and Articles of Association prohibit the issue of bearer instruments?
Yes
No, please provide details.
2.14 Does the Memorandum and Articles of Association prohibit or inhibit co-operation with any authorities whether they be in Gibraltar or elsewhere?
No
Yes, please provide details.
Disclosure of Significant Events
NOTE : For this section the “applicant” should be interpreted as including group or subsidiary entities connected to the applicant as well as the applicant itself.
Significant events
3.1 Does the corporate hold, or has it ever held, any authority from a supervisory body tocarry on any business in Gibraltar or elsewhere? If so, give particulars. If any suchauthority was revoked, give particulars.
NoYes
3.2 Has the corporate ever applied for any authority from a supervisory body to carry onbusiness in Gibraltar or elsewhere other than an authority already mentioned in answer toquestion 3.1. If so, give particulars. If any such application was, for any reason, refused or withdrawnafter it was made, give particulars.
NoYes
3.3 Has the corporate within the last 10 years failed to satisfy a judgement debt under acourt order in Gibraltar or elsewhere within a year of the making of the order? If so, giveparticulars.
NoYes
3.4 Has the corporate made any compromise or arrangement with its creditors within the last10 years or otherwise failed to satisfy creditors in full? If so, give particulars.
NoYes
3.5 Has a receiver or an administrative receiver of any property of the corporate beenappointed in Gibraltar, or has the substantial equivalent of any such person been appointed inany other jurisdiction, in the last 10 years? If so, give particulars, including whether the receiveror equivalent is still acting under the appointment.
NoYes
3.6 Has a petition been served in Gibraltar for an administration order in relation to thecorporate, or has the substantial equivalent of such petition been served in any otherjurisdiction, in the last 10 years? If so, give particulars.
NoYes
3.7 Has a notice of resolution for the voluntary liquidation of thecorporate been given inGibraltar, or has the substantial equivalent of such a notice been given in any otherjurisdiction, in the last 10 years? If so, give particulars.
NoYes
3.8 Has a petition been served in Gibraltar or elsewhere for the compulsory liquidation of thecorporate, or has the substantial equivalent of such a petition been served in any otherjurisdiction, in the last 10 years? If so, give particulars.
NoYes
3.9 Is an inspector or other authorised officer of any government department or agency,professional association or other regulatory body appointed under any Gibraltar or overseesenactment investigating, or has such an investigation ever previously taken place into, theaffairs of the corporate? If so, give particulars.
NoYes
3.10 Has the corporate ever been censured, prosecuted, warned as to future conduct, disciplinedor publicly criticised by, or made the subject of a court order at the investigation of, anyregulatory authority in Gibraltar or elsewhere? If so, give particulars.
NoYes
3.11 Has the corporate ever been refused entry, in Gibraltar or elsewhere, to any professionalbody or trade association concerned with banking or financial activities or decided not toapply for entry after making an approach? If so, give particulars.
NoYes
3.12Is the corporate engaged, or does it expect to be engaged, in Gibraltar or elsewhere in anylitigation which may have material effect on the resources of the controller or the firm? If so, giveparticulars.
NoYes
Explanations
3.13 If the answer to any of questions 3.1 to 3.12 is Yes, please give a full explanation of the events in question on a separate sheet of paper.
Make sure you include:
•the question number the event refers to;
•the date of the event;
•any amounts involved;
•the outcome; and
•an explanation of the circumstances.
Owners and Influencers
Controllers
4.1 Please give details of the controllers (of the body corporate to which this form relates) below.
1 to 7 controllers – please give details of the controllers below
More than 7 controllers
If the ownership structure has more than seven controllers or is too complicated to show the nature of the relationship between the firm and each of the controllers (of the body corporate to which this form relates) from the details below, please provide a structure chart on a separate sheet of paper.
The structure chart should show the nature of the relationship between the firm and each of its controllers (of the body corporate to which this form relates). It must also include the information asked for below.
Structure chart provided on separate sheet.
Name / Legal status of controller / Direct Holding / Indirect HoldingNumber of Shares / Voting Rights / Number of Shares / Voting Rights
% / % / % / %
% / % / % / %
% / % / % / %
% / % / % / %
% / % / % / %
% / % / % / %
% / % / % / %
4.2 Are any of these voting rights (exercised directly or indirectly) held through a trust?
No
Yes, please provide details.
4.3 Is the corporateengaged, or does it expect to be engaged, in any transactions orarrangements (excluding receipt of dividends) with the firm? If so, give particulars.
No
Yes, please provide details.
4.4 Is any business of the corporate guaranteed or otherwise underwritten or secured, or expectedto be guaranteed or underwritten or secured, by the firm, for example, by the giving of securityto a bank in respect of lending to the corporate/group company? If so, give particulars.
No
Yes, please provide details.
4.5 Is any business of the corporate guaranteed or otherwise underwritten or secured, or expectedto be guaranteed or underwritten or secured, by the firm, for example, by the giving of securityto a bank in respect of lending to the controller/group company? If so, give particulars.
No
Yes, please provide details.
4.6 How many shares in the firm are registered in the name of the corporateor an associate? Givename(s) in which registered and class of shares.
4.7 In how many shares in the firm (not being registered in the name of the corporate or anassociate) is the corporate or any company in the same group or any related partybeneficially interested?
4.8 Are any of the shares in the firm mentioned in answer to questions 4.6 and 4.7 equitably orlegally charged or pledged to any part? If so, give particulars.
No
Yes, please provide details.
4.9 Please provide audited accounts for the corporate (and, where appropriate, auditedgroup accounts for the corporate’s group) for the last three financial years (if available). Ifthe most recent audited accounts are more than six months out of date, they should beaccompanied by management accounts (which need not be audited) showing the current financialposition and the current results of the controller.
Audited Accounts of the corporateattached to application.
The corporate warrants and undertakes:
I/We certify that the above information supplied in answer to the questions above and those provided in the attached sheet(s) are accurate and correct to the best of my/our knowledge.
I/We undertake to inform the Financial Services Commission of any changes material to this declaration which may arise.
Dated / dd/mm/yySigned
Position
Signed
Position
Signed
Position
For and on behalf of (name of the applicant);
Statement on Data Protection
The Financial Services Commission is exempted by Section 19 of the Data Protection Act 2004 (the “Act”) from many of the provisions of the Act which includes the Obligation to Register, Principles for data quality and security, information to be given to data subjects, data subject’s access and rectification of data (sections 24, 6, 10, 14 and 15 of the Act). However, to the maximum extent possible, the FSC will follow the obligations imposed by the Act unless it considers that compliance would be likely to prejudice the proper discharge of its functions or prejudice its purposes.
Data Controller
Financial Services Commission of PO Box 940, Suite 943 Europort, Gibraltar.
Purposes for which data is collected and processed
The Financial Services Commission (FSC) is under a statutory obligation to ensure that those persons who exercise control or significant influence or control over the operations of a regulated financial firm be fit and proper as well as to ensure that they have the correct training and competency to conduct that activity. As such the FSC may conduct enquiries on such individuals for these purposes.
Recipients of data
In order to conduct this role, the Financial Services Commission may pass or be required to confirm some or all of the aspects of the data that you have provided with other regulators who perform similar roles to the FSC or law enforcement agencies within Gibraltar or in other jurisdictions.
Similarly, other regulators and law enforcement agencies may seek to confirm with the FSC details of data that you may have supplied to them.
Subject to the confidentiality provisions that the FSC, its officers and staff are subjected to under various regulatory Acts for which it has responsibilities and the restrictions imposed upon it by the Act, the FSC will share your data only for the purposes provided therein.
Your rights to access data held by the FSC on you.
Upon receipt of a written request and subject to being able to prove that the person making the request is the data subject, the FSC will confirm whether or not we hold personal data about you and if so, what this data is. This data will be provided to you in a readily understood format.
The fee for receiving this information is £25 and must be made in a form available from the FSC’s web-site at Alternatively, these forms are available from our reception at Suite 943 Europort or one can be forwarded to you by calling (+350) 40283.
Your right to rectify data held by the FSC on you
If data held by the FSC on you is inaccurate or out of date you can require the FSC to update the data by making this request in writing.
Your right to complain about your treatment to the Gibraltar Data Protection Commissioner
If you consider that the FSC has not complied with the requirements of the Act you may make a complaint to the Data Protection Commissioner:
Gibraltar Data Protection Commissioner
Gibraltar Regulatory Authority
Suite 811, Europort
Gibraltar
Tel +350 74636
Fax +350 72166
Human Rights
Irrespective of anything contained in this statement, your rights under the European Convention on Human Rights and the Gibraltar Constitution Order remain unfettered.
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