APPLICATION FORMS AND NOTICES (AFN) – AUT-CORE
For DFSA use only
Form AUT - CORE
Applying for Authorisation
Core Information form
This form must be submitted by all applicants applying for a Licence to carry on one or more Financial Services, as defined in the GEN Module of the DFSA Rulebook, unless the Financial Service you propose to carry on is limited to acting as a Fund Manager of an Exempt Fund.
The Notes for Applicants contains information that may assist you in completing this form. Please refer to the section entitled “Core Information form” in the notes. Each note is linked to a specific question in this form via a referenced number. Please note that in addition to this form, you may be required to complete other supplementary forms as applicable to your activities.
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SECTION 1: GENERAL INFORMATION
CF1. Full name of the firm applying for authorisation.
CF2. Legal nature of the applicant.
CF3. Are you a DIFC entity or non-DIFC entity?
CF4. Are you a start-up? Yes No
CF5. Are you, or your Parent, regulated? If yes, please provide contact details of the regulator responsible for the authorisation and ongoing supervision of you or your Parent.
CF6. Please complete the matrix below indicating the Financial Services you propose to undertake in respect to each Investment or financial product as applicable.
t * s s i s s s s s t s t t t i e s d e e e c c t n n r r r s n e a u a a o r a u u i e r t r t U c t d t h r i C n n u f i p o n i a S r e t F s o r O b P u W
C e e
B d I
C l D e T r a i L u
c t a n c
r a u r e n t i d S F n
u c i
s t m h a l g s i I
Proposed Financial Services Activities R 1. Accepting Deposits 2. Providing Credit 3. Dealing in Investments as Principal 4 Dealing in Investments as Agent 5. Arranging Credit or Deals in Investments 6. Managing Assets 7. Advising on Financial Products or Credit 8. Managing a Collective Investment Fund 9. Providing Custody 10 Arranging Custody 11. Insurance Intermediation 12. Insurance Management 13. Managing a PSIA** 14. Operating an Alternative Trading System 15 Providing Trust Services 16. Providing Fund Administration 17. Acting as the Trustee of a Fund
*LTI Long Term Insurance Contract ** PSIA Profit Sharing Investment Account
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Class Activity All I II III IV V VII 1 2 3 4 5 6 7 8 Effecting Contracts of Insurance Carrying out Contract of Insurance
Note: Classes of insurance are set out in APP 4 of the GEN module of the DFSA Rulebook.
CF7. Will you be conducting Islamic Financial Business? Yes No CF8. Please list any applications being made for a waiver / modification of DFSA Rules.
CF9. What type of Clients will you have?
Retail Professional CF10. Date and place of incorporation.
CF11. Financial year-end (DD/MM).
CF12. Trading names (if different from legal name).
CF13. Will your business be heavily dependent on bespoke IT systems? Yes No
If yes, please provide a description of the systems and whether you or your Group is already using these systems.
Controllers
CF14. Please identify all your Controllers. Provide the name and date of birth for each Controller that is an individual and for each of the board members of all corporate Controllers.
Contact details
CF15. Name of contact person for application. Please provide telephone, fax, e-mail and postal address.
CF16. Name and contact details of professional adviser(s) assisting with the application, if any.
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CF17. Would you like us to copy in your adviser on any correspondence?
Yes No CF18. Registered and current / proposed business address for the DIFC operation, if known.
CF19. Your head office address (if different to CF18).
CF20. Website address.
CF21. Name and contact details of your auditor. Is your auditor DFSA Registered? Yes No
Documentation
Documents attached Yes No CF22. Regulatory business plan CF23. Incorporation certificate CF24. Board minute approving establishment of the DIFC entity CF25. Résumés/CVs for the individual Controllers, if applicable CF26. Résumés/CVs for the members of the board of Directors (both executive and non-executive) for the applicant and all corporate Controllers (including date of birth) as applicable. CF27. AUT-IND1 form (one for each proposed Authorised Individual) CF28. Last audited accounts (if previously trading) CF29. Last audited Group accounts (if applicable) CF30. Financial projections, including: quarterly cash flow forecast quarterly profit & loss account, split into income streams quarterly forecast of your Capital Resources versus your Capital Requirement quarterly balance sheet ISAE 3400 – The Examination of Prospective Financial Information report (for Category 1, 2 and Insurers only). Note: provide all projections commencing at the time of authorisation and on a quarterly basis for each of the first three financial years after licensing CF31. Evidence of source of funds for start-up
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Compulsory Supporting Documents
At the time of submission of this form, the following supporting documents must be complete and be ready for inspection by the DFSA.
By ticking the “Complete, and ready to be inspected” box, you are confirming the supporting documents meet all applicable standards and contain all necessary provisions taking into account the nature, size and complexity of your proposed activities, The DFSA may request inspection of the supporting documents at any stage.
Please note if you are a start-up entity, you should attach all the supporting documents below before the DFSA will accept the application.
Supporting Document All applicants documents attached – Start-Ups
CF32. Compliance Manual Complete, and ready to be inspected Yes No CF33. Anti-Money Laundering Complete and ready to be inspected Yes No Procedures CF34. Compliance Monitoring Complete and ready to be inspected Yes No Programme CF35. Risk Management Policies Complete and ready to be inspected Yes No
Fees
Applications will not be processed until the relevant fee is paid in full to the DFSA. Details of the application fees are contained in the Fees module of the DFSA Rulebook.
Please make the payment by Bank transfer in US Dollars to the account listed below. Cheques or bank drafts will not be accepted.
Account name Dubai Financial Services Authority Account number 020-683751-100 Bank details HSBC Bank Middle East PO Box 66 Dubai, UAE Swift code BBMEAEAD Reference to be quoted Application fee – [applicant name]
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SECTION 2: REGULATORY BUSINESS PLAN
You are expected to attach a regulatory business plan with this form at the time of submission.
Please refer to ‘Part 2: Notes on what the DFSA expect to see in a regulatory business plan’ in the Notes for Applicants booklet. You are expected to cover each point which is referenced.
SECTION 3: PRUDENTIAL REGULATORY REPORTING
CF36. If you are not an Insurer, what prudential Category will you be?
CF37. Which accounting standards will you use in preparing the financial accounts and statements?
CF38. Please confirm that you will be able to use the DFSA’s Electronic Prudential Reporting System to submit the required prudential regulatory returns.
SECTION 4: FIT AND PROPER QUESTIONNAIRE AND DECLARATION
Please note: If the answer to any of the following questions is yes, please provide details, attaching separate sheets/documentation as necessary.
Have you or any member of your Group in the last 10 years:
CF39. Been convicted or found guilty by any court of a competent jurisdiction of any offence? Yes No CF40. Ever been the subject of disciplinary procedures by a government body or agency or any self-regulatory Yes No organisation or other professional body? CF41. Contravened any provision of financial services legislation or of rules, regulations, statements of principle or codes of practice made under it or made by a self-regulatory organisation, Financial Services Regulator, Authorised Yes No Market Institution or regulated exchange or clearing house? CF42. Been refused or had a restriction placed on the right to carry on a trade, business or profession requiring a Yes No licence, registration or other permission? CF43. Received an adverse finding or an agreed settlement in a civil action by any court or tribunal of competent jurisdiction resulting in an award against or payment in excess of Yes No $10,000 or awards that total more than $10,000? CF44. Been censured, disciplined, publicly criticised or the subject of any investigation or enquiry by any regulatory authority, Financial Services Regulator or officially Yes No appointed inquiry?
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Disclosure of information to the Dubai International Financial Centre Authority (DIFCA)
The provision of certain information by the DFSA to the DIFCA under the following consent will assist the DIFCA in exercising its functions and powers. It is not mandatory to provide consent and should you not wish to provide consent, we ask that you consider keeping the DIFCA informed of the progress of your application.
I consent / I do not consent to disclosure of the following information by the DFSA to DIFCA:
1. The fact of the filing of this application, together with the name of the applicant;
2. The fact (if applicable) that this application is still being reviewed by the DFSA; and
3. The outcome of this application. An outcome may include a decision by the DFSA to approve this application, in principle or otherwise, or to reject the application or the withdrawal of the application.
Declaration by the applicant
1. I declare that, to the best of my knowledge and belief, having made due enquiry, the information given in this form, the supplements and documents attached, as well as any applicable supporting documents, 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 declare my understanding that the DFSA may request more detailed information (including but not limited to, personal, educational, employment and financial information) should it be deemed necessary to adequately assess the fitness and propriety of the firm or any person connected to the firm. I consent to the DFSA contacting any previous employers, educational institutions, professional organisations or any other organisation, to verify any information contained in this form.
3. I confirm that I have the authority to make this application, to declare as specified above and sign this form for, or on behalf of, the applicant. I also confirm that I have the authority to give the consent specified above.
4. For the purposes of complying with DIFC Data Protection Law 2007, I understand that any Personal Data provided to the DFSA will be used to discharge its regulatory functions under the Regulatory Law 2004 and other relevant legislation and may be disclosed to third parties for those purposes.
Signature of Director/Partner of the Date applicant*
Name of Director/Partner of the applicant*
Position/title
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Signature of Director/Partner of the Date applicant*
Name of Director/Partner of the applicant*
Position/title
*Or the person who will be authorised by the entity once it has been incorporated or established within the DIFC.
Please return the completed form to:
Dubai Financial Services Authority Level 13, The Gate Building, Dubai International Financial Centre PO Box 75850, Dubai, UAE
Firms are advised to retain a copy of this form, any supplement and all attachments for their records.
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