for money service business

APPLICATION FORM For Money Service Business

FOR REGISTRATION UNDER ARTICLE 9 OF THE FINANCIAL SERVICES (JERSEY) LAW 1998

NAME OF MONEY SERVICE BUSINESS NAME OF PRINCIPAL CONTACT AND THEIR POSITION CORRESPONDENCE ADDRESS TELEPHONE NO. FACSIMILE NO. E-MAIL ADDRESS Additional copies of this Application Form are available from the Commission’s website at www.jerseyfsc.org

The information contained within this application form is restricted information within the meaning of Article 37 of the Financial Services (Jersey) Law 1998.

Jersey Financial Services Commission Money Service Business - Application Form

HOW TO USE THIS FORM 1. In this form references to the “Applicant”, are to the company, partnership or individual applying to be registered

under Article 9 of the Financial Services (Jersey) Law 1998 (‘the Law’) due to their turnover exceeding the exception threshold. It is not to be read as a reference to the directors, related businesses or any Principal Person - where information about these persons is required, the questions ask for this information from the Applicant.

2. Applicants must submit a completed Application Form in “paper” format, together with any supporting

documents. Applicants are to include a cheque for the registration fee. (Cheques should be made payable to the “Jersey Financial Services Commission’ and crossed ‘A/C Payee’).

Please send all completed forms and documentation to:- Money Services Business Authorisation Jersey Financial Services Commission, P.O. Box 267 14-18 Castle Street, St. Helier, Jersey, Channel Islands. JE4 8TP

3. The Jersey Financial Services Commission (‘the Commission’) has determined that application for registration

under Article 9 of the Law must be made on this form; any deviation from the prescribed form may invalidate the application.

4. All questions where appropriate should be answered with answers either typed or printed in black ink in block

capitals. Answer boxes in this form can be extended to provide more space. 5 This application form should be completed on the basis of information that is known by the Applicant. Where

information is not available, or matters are unknown, the Applicant should say so. 6. Applicants must consider the full effect of the Law and its associated subordinate legislation and Codes of Practice

in completing this form. 7. All undefined terms are to be interpreted as in the Law. Applicants are reminded that "companies" includes

companies incorporated in or outside the Island of Jersey unless the context requires otherwise. 8. Failure to complete the application may mean it is not duly made under Article 8 of the Law, and will not be

considered. 9. All signatures must be original. 10. Where the Applicant is required to complete a Section, no question should be left blank. If a question does not

apply the Applicant should write “Not Applicable”. 11. Where the Applicant is required to give a value it should be in Sterling or the Sterling equivalent. 12. Please ensure that all questions in the Application Form are completed and any additional information required is

provided on the ‘Notes’ pages at the back of each section of the form. 13. Copies of the Application Form and supplementary documents should be retained for your own records. The Commission reserves the right to make such requests for additional information as it thinks fit under its general powers. If you would like to discuss the completion of this form prior to submitting to the Commission please do not hesitate to contact:-

Money Service Business Authorisation - Telephone 822000

Data Protection (Jersey) Law 2005 (“Data Protection Law”)

Personal data provided in this application will be used by the Commission – a data controller as defined in the Data Protection Law - to discharge its statutory functions under Financial Services (Jersey) Law 1998, as amended, and it may be disclosed to third parties for those purposes. Further information may be found in the Commission’s data protection policy, copies of which are available on request from the Commission and which may also be found on www.jerseyfsc.org.


CONTENTS Section 1 - Status of Applicant Section 2 - Family Tree / Ownership Section 3 - Business Background Section 4 – Questionnaire Section 5 - Declaration


SECTION 1 - STATUS OF APPLICANT 1.1 Name of Applicant (refer to front page of this Application Form):

1.2 Nature of Applicant (please tick):

Company Partnership Sole Trader

Other (please specify) 1.3 Date, country or territory, nature of incorporation / partnership formation:

Day/Month/Year Place/Country

Registered Number or equivalent

1.4 What type of money service business does the Applicant operate:

Bureau de change Cheque casher

Transmitting/receiving funds by wire or other electronic means

Money transmission services

1.5 Address of Registered Office:

Telephone No. (inc. STD code) Facsimile No. (inc. STD code) Email address

1.6 Principal place of business in Jersey:

Telephone No. (inc. STD code) Facsimile No. (inc. STD code) Email address


1.7 Please list the Name and address of Principal Persons (as defined in Article 1(1) of the Financial Services (Jersey)

Law 1998 (“FS Law”)) and, in the case of overseas applicants, the individual(s) in Jersey who will have local management responsibility for the money service business:

Note: All individuals listed below are required to submit Personal Questionnaires.

SURNAME FORENAME(S) RESIDENTIAL ADDRESS

1.8 Does the Applicant conduct or carry out financial services business from jurisdictions outside Jersey? If so, please

provide details of the address outside Jersey that financial services business is carried out:

1.9 State all other addresses of offices in Jersey in which or from which financial services business is to be carried on:

Address

Telephone No. (inc. STD code) Facsimile No. (inc. STD code) Email address Contact Name Website (if applicable)

1.10 Is the Applicant / has the Applicant applied to regulatory authorities in other jurisdictions. If yes, please provide

details:

1.11 State all trading names currently used by the Applicant:


1.12 State all former trading names used by the Applicant during the previous ten years. Please give details of former

names and the dates they were changed:

Previous Name(s)

Date of Change

SECTION 2 - FAMILY TREE / OWNERSHIP 2.1 Please provide information relating to the ultimate beneficial owner(s) of the Applicant and where the Applicant is

part of a group show percentage sizes of holdings and controlling share capital:

Note 1: This Section does not have to be completed if the Applicant is a publicly listed company on a recognised Stock Exchange. Note 2: The Applicant may elect to provide this information on a Group Structure Chart. The Group Structure Chart should show percentage sizes of holdings and controlling share capital. A handwritten structure chart will be acceptable.

(Values in “local” currency can be stated)

Type of Shares (eg Ordinary)

Number of shares Nominal or Par value of shares

Authorised share capital Issued share capital

Shareholder’s Name Number of

shares Type of shares

Nominal or Par value of shares

2.2 Status of Shareholders Do any of the Applicant’s shareholders hold shares as a nominee?

Yes No If Yes, please provide details of the ultimate beneficial owner:

2.3 Status of Shares Are any of the shares subject to a charge, lien or other encumbrance?

Yes No If Yes, please provide details of the charge, lien etc. including beneficiary information:

2.4 Indicate below whether any of the entities shown on the Family Tree are conducting financial services in or from

within Jersey (eg. Banking, Insurance, Investment, Consumer Credit Services, Trustee Services etc). If applicable, please provide details of the entity, the nature of business carried out and in which countries or territories the services are delivered:

2.5 If the Applicant is owned, or partly owned by a corporate entity (eg. a holding or nominee company etc) please

provide details of structure and of beneficial ownership:

SECTION 3 BUSINESS BACKGROUND 3.1 How many people are directly employed by the Applicant in Money Service Business activities within the Island?


3.2 Indicate the most frequent value of your transactions:

[Please select one choice from below] £1-£250 £251 - £500 £501 - £1,000 £1,001 - £3,000 £3,001 - £10,000 >£10,000

3.3 Please estimate the percentage of transactions per year are above £10,000?

% 3.4 What is the approximate annual turnover in respect of all Money Service Business activity?

Bureau de change £ Money transmitter £ Cheque casher £

3.5 What are the three main currencies changed or transmitted in exchange for sterling?


SECTION 4 QUESTIONNAIRE If any of the following questions are answered “Yes”, please provide further details at the end of this section 2.1 Is the Applicant regulated by “a relevant supervisory authority”? (Defined in the Financial Services (Jersey) Law

1998)

Yes No 2.2 Does the Applicant have any other licence, membership, recognition, exemption, authorisation or registration

conferred by any body (including investment exchanges and clearing houses) whether in Jersey or elsewhere in respect of Financial Business?

Yes No

2.3 Has the Applicant carried out any other business activities in or from within Jersey in the past five years?

Yes No 2.4 Has the Applicant at any time been refused or had revoked any other licence, membership, recognition,

exemption, authorisation or registration by any body, or having made an application decided not to proceed with it?

Yes No

2.5 Has the Applicant at any time in the previous ten years been criticised, censured, disciplined, suspended, expelled,

fined or been subject of any disciplinary action by any regulatory body in Jersey or by any relevant supervisory authority or any Professional Body? Yes No

2.6 At any time in the previous ten years, has an application been made for the bankruptcy or compulsory winding-up

of the Applicant, or for the sequestration of the Applicant’s estate, or for the Applicant’s property to be declared en désastre? Yes No

2.7 Has the Applicant at any time in the previous ten years had a receiver or administrator appointed, failed to satisfy

a debt adjudged due, or come to a compromise or similar arrangement with any of its creditors?

Yes No

2.8 Has the Applicant been the subject of a reconstruction, including merger, take-over etc in the previous ten years?

Yes No 2.9 Has any company of which the Applicant controlled 50% or more been wound-up as an insolvent company, or on

public interest grounds, or had its property declared en désastre, or had an administrator or receiver appointed at any time in the previous ten years?

Yes No

2.10 Has the Applicant been involved in the management of a company which has been an insolvent company, been

wound up on public interest grounds, or had its property declared en désastre, or had an administrator or receiver appointed at any time in the previous ten years?

Yes No

2.11 Is the Applicant aware that its affairs, at any time in the previous ten years, have been investigated (including

whether or not yet completed) by any regulatory body in Jersey or by any relevant supervisory authority or government or its agencies or any Professional Body? Yes No

2.12 Have any of the Applicant’s books and records (including customer books and records) been requisitioned or

seized at any time in the previous ten years by a relevant supervisory authority or any government or its agencies?

Yes No 2.13 Has the Applicant been engaged in any civil proceedings or arbitration at any time in the previous ten years in

which a debt was adjudged due from, or judgement given against, the Applicant in relation to any financial services?


Yes No 2.14 Has any settlement of £10,000 or greater been entered into at any time in the previous three years, whether or not

on an ex-gratia basis, to avoid or bring to an end legal action being brought against the Applicant, or to avoid adverse publicity for the Applicant, in relation to any financial services?

Yes No

If YES, please provide details of number and value of “settlements” made:

2.15 Has the Applicant at any time been convicted of any offence involving fraud, or other dishonesty, or an offence

under legislation (whether or not in Jersey) relating to companies (including insider dealing), financial service business, insolvency, customer credit or consumer protection?

Yes No


2.16 Has the Applicant any convictions for any offence (excluding minor traffic offences) other than offences listed

above, or been subject to penalties for tax evasion?

Yes No

2.17 Is the Applicant involved in any pending proceedings or regulatory action that are of a type that could in due course fall within any of the categories of proceedings or action in 2.15 and 2.16 above?

Yes No

2.18 Having regard to Article 9 of the Law, is there any other information about the Applicant, or any employee or

associate of the Applicant, or any person who is a principal person in relation to the Applicant which may have a bearing on the Commission’s decision in determining this Application ?

2.19 Please provide an accompanying 3 year business plan for the applicant’s whole business showing forecasts of

business, revenue and expenditure on an annual basis.

Within the business plan referred to above, the Commission requests details of the following particular topics:

1. Organisation charts giving details, including qualifications, relevant experience etc of all Principal Persons and the Compliance function. (If the Applicant does not have existing staff to undertake specific duties, please indicate numbers only);

2. Details of any outsourcing arrangements or other delegated functions; and

3. How the Applicant intends to meet the requirements of the Money Service Business Codes of Practice.

2.20 Having regard to Article 9 of the Law, is there any other information about the Applicant, or any employee or

associate of the Applicant, or any person who is a principal person in relation to the Applicant which may have a bearing on the Commission’s decision in determining this Application:


SECTION 5 APPLICANT DECLARATION

Name of Applicant hereby applies to be registered under Article 9 of the Financial Services (Jersey) Law 1998

and encloses an application fee of £ and registration fee of £

We are authorised to make this application on behalf of the applicant. We confirm that the information in this application (including on additional sheets and in personal questionnaires) is accurate and complete to the best of my knowledge and belief. We authorise the Commission to make such enquiries and to seek such further information as it thinks appropriate to verify the information given on this form. We are aware that it is a criminal offence under Article 28 of the Financial Services (Jersey) Law 1998, as amended, to knowingly or recklessly provide any information which is false or misleading in a material particular. We will notify the Commission immediately of any significant change to the information given in this application. We understand that the Commission may require me to provide further information or documents at any time after I have sent the application and before the applicant has been registered. We understand and accept that the Commission may wish to make enquiries on a continuing basis to satisfy itself as to the continuing fitness and propriety of the applicant. Signed by the two Principal Persons named below on behalf of the Applicant. Signed for and on behalf the Applicant by Name

Name

Position held

Position held

..................................................... ..................................................... Signature Signature

Data Protection (Jersey) Law 2005 (“Data Protection Law”)

Personal data provided in this application will be used by the Commission – a data controller as defined in the Data Protection Law - to discharge its statutory functions under the Financial Services (Jersey) Law 1998, as amended, and it may be disclosed to third parties for those purposes. Further information may be found in the Commission’s data policy, copies of which are available on request from the Commission and which may also protection be found on www.jerseyfsc.org.


CHECKLIST OF ITEMS TO BE SUBMITTED TO THE COMMISSION IN RESPECT OF THE APPLICATION FORM

1. Is a cheque for the application fee and the first annual fee made payable to the “Jersey Financial Services

Commission” enclosed? 2. Are all the Personal Questionnaire(s) attached? 3. Are all the additional information sheets attached? 4. Have you taken a copy of the completed Application Form to be submitted to the Jersey Financial Services

Commission for your own reference and security reasons?

for money service business

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