Appointment of a Distributor by Yvu8VD4

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									       Application Form for the Appointment of Distributors by an EMI under Regulation 20 of European
       Communities (Electronic Money) Regulations 2011




                                                       APPLICATION FORM FOR THE
                                            APPOINTMENT OF DISTRIBUTORS BY AN
2011




                                           ELECTRONIC MONEY INSTITUTION (‘EMI’)
                                            Under Regulation 20 of European Communities (Electronic
                                                     Money) Regulations 2011 (‘the Regulations’)




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Application Form for the Appointment of Distributors by an EMI under Regulation 20 of European
Communities (Electronic Money) Regulations 2011




    NOTES ON COMPLETION


    1. This application must be completed by the EMI (typed format) and
         submitted to the Central Bank of Ireland at least 30 days in advance of
         any proposed appointment of distributor.


    2. All questions must be completed before the application can be considered.
         If a question does not apply, please write not applicable or none as
         appropriate. Do not leave any blank spaces. (Incomplete Applications
         will be returned.) If the applicant is unable to submit any of the
         documentation requested below please give an explanation in the covering
         letter (referring to the section number). Outstanding documentation will
         delay the notification process.


    3. Where applicants are required to ‘confirm’, a tick (‘’) placed in the
         relevant box will be taken as a confirmation.


    4. If insufficient space has been provided for a reply or if the answer is
         requested on a separate sheet, please provide that information on a
         separate sheet and refer to it in the space provided for the answer. Please
         ensure that any sheets are clearly marked with the name of the
         organisation and referenced to the appropriate question.


    5. Any questions that have a YES/ NO box should be completed accordingly.


    6. Further information or clarification may be requested (having regard to the
         replies furnished) for the purpose of considering and evaluating an
         application.

    7.   A separate application must be made in relation to each proposed
         distributor.




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      Application Form for the Appointment of Distributors by an EMI under Regulation 20 of European
      Communities (Electronic Money) Regulations 2011



Name of EMI (i.e. the ‘Applicant’):
Central Bank of Ireland
Supervisory Code for EMI1:
Member State in which the
Distributor is to be appointed:



                                                     Distributor Details




                                                                                        Reference2
                                                                                        Document




                                                                                                       Applicant




                                                                                                                   Bank of
                                                                                                                   Central

                                                                                                                   Ireland
1.1          Contact Details
1.1.1        EMI/Applicant EMI
             Disclose details of a principal of the Applicant, in the State, who will
             accept service of any document/correspondence in respect of this
             application:
      (a)    Contact Name:

      (b)    Address:


      (c)    E-mail Address:
      (d)    Telephone Number:
      (e)    Facsimile Number:

1.1.2        Legal Advisors (if applicable)
             Disclose details of the EMI’s solicitors, or other advisors, the
             date of their appointment and the applicant’s contact at the firm:
      (a)    Contact Name:
      (b)    Address:


      (c)    Date of Appointment:
      (d)    E-mail Address:
      (e)    Telephone Number:

      (f)    Confirm that the Central Bank of Ireland can liaise with the named
             legal advisors in respect of the application.

1.2          Distributor Details
             Confirm that the following information is disclosed in the
             Programme of Operations (in relation to the Distributor):
1.2.1
    (a)      Distributor name (i.e. legal and trading name);
    (b)      Legal status of distributor (e.g. limited company, sole trader, etc);
    (c)      Distributor address (i.e. registered and head office);
    (d)      Distributor contact details (i.e. telephone, fax and e-mail address);
    (e)      Details of the directors and persons responsible for the
             management of the distributor (clearly setting out their position,
             e.g. director, managing director); and
      (f)    Proposed date of appointment.



      1
          Where the notification is made subsequent to the EMI’s authorisation.
      2
       Insert reference in the format – document abbreviation-page number-section number/paragraph
      number of the relevant document.


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       Application Form for the Appointment of Distributors by an EMI under Regulation 20 of European
       Communities (Electronic Money) Regulations 2011



1.2.2        Organisational Structure
    (a)      Details of how the distributor fits into the organisational structure of
             the firm;
      (b)    Description of the distributor’s structural organisation (number of
             business units/premises, number of employees, and organisational
             chart showing functional and reporting lines);
      (c)    Description of outsourcing arrangements;
      (d)    Description of participation or intention to participate in a national
             or international payment system;
      (e)    Anti-money laundering procedures; and
       (f)   Details of links with internal control system of the EMI.

             (If these have been previously notified to the Central Bank
             the applicant should confirm this, including confirmation
             that there have been no changes made to the details
             previously notified.)

1.3          Distributors in Other EEA States3
             Confirm that the following document is completed and attached:
      (a)    Schedule to Standard Notification Form for engagement of a
             Distributor, or natural or legal person located in a Host Member
             State

1.4          All Distributors
1.4.1        Confirm that:
    (a)      There is/will be a written contract in place between the applicant
             and each distributor.

1.4.2        Confirm that details in relation to the following have been provided
             in the firm’s supporting documentation:
      (a)    Procedures in place to exercise control and effective oversight
             over the distributor;
      (b)    Person within the applicant responsible for management of
             of the relationship with the distributor;
      (c)    Details of activities completed by the distributor; and
      (d)    Details on the specific distribution activities, including:
             (i) Timings and dependencies regarding flows of information
             and funds between the applicant and the distributor;
             (ii) How the activities of distributors impact the applicant’s
             Safeguarding; and
             (iii) How the applicant meets its AML/CTF obligations while
             engaging distributors.


1.4.3        Distributor Agreement
             Confirm that a copy of the proposed agreement to appoint the
             distributor is attached.

1.5          Miscellaneous
1.5.1        Confirm that the applicant has read and understands the provisions



       3
         The Central Bank of Ireland, together with the competent authorities of other Member States, has agreed a common
       terminology and harmonisation of passport notification documents which will be published on the website of the
       European Commission when available.
       An EMI authorised by the Central Bank of Ireland that wishes to avail of the passporting provisions of Directive
       2009/110/EC [‘the EMD’] should review the information contained in this document and forward the necessary
       notifications to the Central Bank of Ireland with this form.



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    Application Form for the Appointment of Distributors by an EMI under Regulation 20 of European
    Communities (Electronic Money) Regulations 2011



         contained in the Regulations and is satisfied that the appointment
         of this distributor will not materially impair:
   (a)   The quality of the firm’s internal controls and the ability of the
         Central Bank of Ireland to monitor the firm’s compliance with all
         obligations laid down in the Regulations; and
   (b)   The continuing compliance of the applicant with the requirements
         of its authorisation under the Regulations.

1.5.2    Confirm that the proposed distributor acting on the applicant’s
         behalf will inform e-money holders of this fact in writing.




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    Application Form for the Appointment of Distributors by an EMI under Regulation 20 of European
    Communities (Electronic Money) Regulations 2011




                                                DECLARATION

[The applicant] applies for the registration of [X] as a distributor under European Communities
(Electronic Money) Regulations 2011on the basis of information supplied with this application and any
additional information supplied to the Central Bank of Ireland in the course of the application.

I/We acknowledge that the Central Bank of Ireland may disclose information in the performance of its
statutory functions or otherwise as may be specifically authorised by law.

I/We acknowledge that the applicant’s anti-money laundering controls have been formulated to comply
in full with the requirements of Directives 2005/60/EC and 2006/70/EC and applicable legislation and
that I/we shall review and amend these controls in due course and on an ongoing basis to ensure they
are in compliance with all relevant legislation, including, where applicable:
a) the Criminal Justice (Money Laundering and Terrorist Financing) Act 2010; and
b) all codes of practice applicable to EMIs, as soon as is reasonably practicable following their
     approval by the Minister for Justice.

I/We warrant that I/we have truthfully and fully answered the relevant questions in this form and
disclosed any other information which might reasonably be considered relevant for the purpose of the
application.

I/We warrant and I/we will promptly notify the Central Bank of Ireland of any changes in the
information I/we have provided and supply any other relevant information which may come to light in
the period during which the application is being considered and, the application is accepted, thereafter.

I/We warrant that I/we are authorised to make this application for authorisation on behalf of [insert
name of applicant].

Dated this                             day of                           20

Signed:                                Position:

Signed:                                Position:

For and on behalf of:


(Please print name of the Applicant. At least two directors, including the managing director, must sign
the declaration. Original signatures are required.)

Provisions in this document should not be deleted or amended in any manner. Pursuant to
Regulation 69 of European Communities (Electronic Money) Regulations 2011, it is an
offence to knowingly or recklessly make a false or misleading statement in an application for
authorisation to operate as an electronic money institution, or make a false or misleading
statement to the Central Bank of Ireland in relation to the obtaining of an authorisation to
operate as an electronic money institution, or an approval, waiver or permission from the
Central Bank of Ireland concerning the operation of an electronic money institution.




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Application Form for the Appointment of Distributors by an EMI under Regulation 20 of European
Communities (Electronic Money) Regulations 2011




               T +353 1 224 6000       F +353 1 671 6561        www.centralbank.ie




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