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					Universal Application Form
Authorisation Profile




Name of Applicant


Date Received

                             Version 1.00 – Aug 2009
                              Universal Application form for Financial Services authorisation




      Authorisations being sought

 1.1 Financial Services (Banking) Act
                                                        No          Yes
      Credit Institution                                                          Complete section 2.1

                                                        No          Yes
      E-Money Institution                                                         Complete section 2.2


 1.2 Financial Services (Investment & Fiduciary Services) Act

1.2.1 Non-Mifid Investment Business
                                                        No          Yes
      Investment Dealer                                                           Complete section 3.1

                                                        No          Yes
      Investment Broker                                                           Complete section 3.1

                                                        No          Yes
      Investment Manager                                                          Complete section 3.1

                                                        No          Yes
      Investment Adviser                                                          Complete section 3.1


1.2.3 Insurance Intermediation
                                                        No          Yes
      General Insurance Intermediary                                              Complete section 3.2

                                                        No          Yes
      Life Assurance Intermediary                                                 Complete section 3.3


1.2.4 Fiduciary Services
                                                        No          Yes
      Company Manager                                                             Complete section 3.4

                                                        No          Yes
      Professional Trustee                                                        Complete section 3.5


1.2.5 Insurance Management
                                                        No          Yes
      Insurance Manager                                                            Complete section 3.7


1.2.6 Exchanges & Clearing Houses
                                                        No          Yes
      Stock Exchange                                                              Complete section 4.1

                                                        No          Yes
      Clearing House                                                              Complete section 4.1




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                              Universal Application form for Financial Services authorisation



1.2.7 Money Services Business
                                                        No          Yes
      Bureaux de Change                                                           Complete section 3.6

                                                        No          Yes
      Money Transmitter                                                           Complete section 3.6


1.3   Financial Services (Markets in Financial Instruments) Act
                                                        No          Yes
      Cat 1 - Unrestricted                                                        Complete section 4.1

                                                        No          Yes
      Cat 2 – Money-Holders                                                       Complete section 4.1

                                                        No          Yes
      Cat 3 - Arrangers                                                           Complete section 4.1


1.4   Financial Services (Collective Investment Schemes) Act
      Collective Investment Scheme                      No          Yes
                                                                                  Complete section 3.1
      Intermediary
      Collective Investment Scheme                      No          Yes
                                                                                  Complete section 3.1
      Manager
      Collective Investment Scheme                      No          Yes
                                                                                  Complete section 3.1
      Depositary
      Collective Investment Scheme                      No          Yes
                                                                                  Complete section 3.1
      Administrator




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                                Universal Application form for Financial Services authorisation



2.1   Banks
                                                                                    Total percentage of gross
      Description of service to be provided
                                                                                    income
      Acceptance of deposits and other                    No          Yes
      repayable funds from the public?
                                                                                                                %
                                                          No          Yes
      Lending?                                                                                                  %
                                                          No          Yes
      Financial leasing?                                                                                        %
                                                          No          Yes
      Money transmission services?                                                                              %
      Issuing and administering means of
                                                          No          Yes
      payment (e.g. credit cards, travellers’                                                                   %
      cheques and bankers’ drafts)?
                                                          No          Yes
      Guarantees and commitments?                                                                               %
      Trading for own account or for
      account of customers in:                            No          Yes
      (a) money market instruments
                                                                                                                %
      (cheques, bills CD’s etc.)?
                                                          No          Yes
      (b) foreign exchange?                                                                                     %
                                                          No          Yes
      (c) financial futures and options?                                                                        %
      (d) exchange and interest rate                      No          Yes
      instruments?
                                                                                                                %
                                                          No          Yes
      (e) transferable securities?                                                                              %
      Participation in share issues and the
                                                          No          Yes
      provision of services relating to such                                                                    %
      issues?
      Advice to undertakings on capital
      structure, industrial strategy and
                                                          No          Yes
      related questions and advice and                                                                          %
      services relating to mergers and the
      purchase of undertakings?
                                                          No          Yes
      Money broking?                                                                                            %
                                                          No          Yes
      Portfolio management and advice?                                                                          %
      Safekeeping and administration of                   No          Yes
      securities?
                                                                                                                %
                                                          No          Yes
      Credit references services?                                                                               %
                                                          No          Yes
      Safe custody services?                                                                                    %




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                               Universal Application form for Financial Services authorisation



2.2   E-Money Institutions
                                                                                   Total percentage of gross
      Description of service to be provided
                                                                                   income
                                                         No          Yes
      Stored value cards?                                                                                      %
                                                         No          Yes
      E-wallets?                                                                                               %
                                                         No          Yes
      Other? (please describe below)                                                                           %




                                                               5
                                Universal Application form for Financial Services authorisation



3.1   Non Mifid Investment Services and Fund Services
                                                                                    Total percentage of gross
      Description of service to be provided
                                                                                    income
      Providing investment advice to                      No          Yes
      customers?
                                                                                                                %
      Providing investment advice in
                                                          No          Yes
      respect of assets held by collective                                                                      %
      investment schemes or broker funds?
      Advising on, dealing or arranging                   No          Yes
      deals in readily realisable securities?
                                                                                                                %
      Advising on, dealing or arranging
                                                          No          Yes
      deals in securities which are not                                                                         %
      readily realisable?
      Advising on, dealing or arranging
                                                          No          Yes
      deals in options or other derivatives                                                                     %
      whether on exchange or OTC?
                                                          No          Yes
      Dealing in investments as agent?                                                                          %
      Establishing, operating, managing or
      winding up regulated collective
                                                          No          Yes
      investment schemes investing in                                                                           %
      shares etc. and units in collective
      investment schemes?
      Acting as trustee, custodian or
                                                          No          Yes
      depositary of collective investment                                                                       %
      schemes?
      Regularly soliciting all customer types
                                                          No          Yes
      to deal in units in collective                                                                            %
      investment schemes?
      Underwriting or sub-underwriting
                                                          No          Yes
      on own account or on behalf of a                                                                          %
      client and/or participation in placings?
      Entering into repurchasing                          No          Yes
      agreements?
                                                                                                                %
                                                          No          Yes
      Safekeeping and administration?                                                                           %
      Controlling customer monies and                     No          Yes
      assets?
                                                                                                                %
                                                          No          Yes
      Safe custody services?                                                                                    %
      Providing credit to enable a client to              No          Yes
      carry out an investment transaction?
                                                                                                                %
      Provision of corporate finance                      No          Yes
      advice?
                                                                                                                %
      Provision of services related to                    No          Yes
      underwriting?
                                                                                                                %
      Provision of foreign exchange
                                                          No          Yes
      services in connection with                                                                               %
      investment services?
      Provision of administration services                No          Yes
      to collective investment schemes?
                                                                                                                %
      Establishing and conducting the
                                                          No          Yes
      business of an investment exchange                                                                        %
      or clearing house?



                                                                6
                                  Universal Application form for Financial Services authorisation




3.2   General Insurance Intermediation
3.2.1 Will you be providing the following service as;
                                                            No          Yes
       Insurance Intermediary?

                                                            No          Yes
       Reinsurance Intermediary?


3.2.2 Services being provided;
                                                                                      Total percentage of gross
       Description of service to be provided
                                                                                      income
                                                            No          Yes
       Accident?                                                                                                  %
                                                            No          Yes
       Sickness?                                                                                                  %
                                                            No          Yes
       Land Vehicles?                                                                                             %
                                                            No          Yes
       Railway Rolling Stock?                                                                                     %
                                                            No          Yes
       Aircraft?                                                                                                  %
                                                            No          Yes
       Ships?                                                                                                     %
                                                            No          Yes
       Goods in transit?                                                                                          %
                                                            No          Yes
       Fire & Natural forces?                                                                                     %
                                                            No          Yes
       Damage to property?                                                                                        %
                                                            No          Yes
       Motor Vehicle liability?                                                                                   %
                                                            No          Yes
       Aircraft liability?                                                                                        %
                                                            No          Yes
       Liability for ships?                                                                                       %
                                                            No          Yes
       General liability?                                                                                         %
                                                            No          Yes
       Credit?                                                                                                    %
                                                            No          Yes
       Suretyship?                                                                                                %
                                                            No          Yes
       Miscellaneous financial loss?                                                                              %
                                                            No          Yes
       Legal expenses?                                                                                            %
                                                            No          Yes
       Assistance?                                                                                                %




                                                                  7
                                 Universal Application form for Financial Services authorisation



3.3   Life Assurance Intermediation & Investment Advice
3.3.1 Will you be providing the following service as;
                                                           No          Yes
       Insurance Intermediary?

                                                           No          Yes
       Reinsurance Intermediary?


3.3.2 Services being provided;
                                                                                     Total percentage of gross
       Description of service to be provided
                                                                                     income
                                                           No          Yes
       Life Assurance & Annuities?                                                                               %
                                                           No          Yes
       Marriage & Birth?                                                                                         %
                                                           No          Yes
       Linked Long Term?                                                                                         %
                                                           No          Yes
       Permanent Health?                                                                                         %
                                                           No          Yes
       Tontines?                                                                                                 %
                                                           No          Yes
       Capital Redemption?                                                                                       %
                                                           No          Yes
       Pension Fund Management?                                                                                  %
                                                           No          Yes
       Collective Insurance, etc?                                                                                %
                                                           No          Yes
       Social Insurance?                                                                                         %




                                                                 8
                                Universal Application form for Financial Services authorisation



3.4   Company Management
3.4.1 Will you be providing the following services?;
                                                    Formation               Management            Administration


                                                    No          Yes          No          Yes        No         Yes
      Companies

                                                    No          Yes          No          Yes        No         Yes
      Partnerships

                                                    No          Yes          No          Yes        No         Yes
      Unincorporated Associations

                                                                                    Number of companies for which
      Description of service to be provided                                         this will be provided in first 12
                                                                                    months
      Will the applicant provide registered               No          Yes
      address facilities?
      Will the applicant provide corporate                No          Yes
      directorships?
      Will the applicant provide nominee                  No          Yes
      shareholdings?
      Will the applicant provide company                  No          Yes
      secretarial services?
      Will the applicant provide officers                 No          Yes
      (other than directors)?
      Please provide details of officers being provided?

      Will the applicant provide mail                     No          Yes
      forwarding services?

3.5   Trusteeship
                                                                                    Number of trusts for which this
      Description of service to be provided                                         will be provided in first 12
                                                                                    months
      Will the applicant act as a                         No          Yes
      professional trustee?




                                                                9
                               Universal Application form for Financial Services authorisation




3.6   Money Service Business
                                                                                   State the turnover, in £GBP,
                                                                                   which this service is expected to
      Description of service to be provided
                                                                                   generate in the first 12 months
                                                                                   of business
      Will the applicant provide the buying,
                                                         No          Yes
      selling, or exchanging of foreign
      currency?
      Will the applicant provide the buying,
                                                         No          Yes
      selling, or exchanging of precious
      metals?
      Will the applicant provide cashing
                                                         No          Yes
      facilities which are payable to
      customers or third parties?
      Will the applicant provide money
      transmission services in or from
      within Gibraltar, as a business;                   No          Yes
      transmitting money, or any
      representation of monetary value, by
      any means.




                                                              10
                     Universal Application form for Financial Services authorisation



3.7   Insurance Management
      Will the company provide any investment service
      which is other than advising a managed company on
      suitable currencies and maturity dates, in order to
      assist the company to make appropriate decisions for                       No    Yes
      the investment of the assets underlying its technical
      reserves, or executing the sale and purchase of
      investments on the specific instruction of managed
      companies?
      Is it proposed that any management functions will be                       No    Yes
      exercised by any other third party?

      Provide a summary of the systems and controls that will be put in place and the
      management information reports to the companies under management that the
      system will generate.




                                                    11
4.1   Investment Services
                                                                        INSTRUMENTS (Section C-see below)
                                                                        1      2        3         4         5   6   7   8   9   10
INVESTMENT SERVICES &                          Person responsible for
ACTIVITIES (section A)                         activity
Reception and transmission of orders in
relation to one or more of the Instruments
listed in section C
Execution of orders on behalf of clients
Dealing in any of the instruments listed in
Section C for own account
Portfolio Management
Investment advice
Underwriting of financial instruments or
placing of financial instruments, listed in
Section C, on a firm commitment basis
Placing of financial instruments, listed in
Section C without a firm commitment
basis
Operation of Multilateral Trading Facilities
                                                                            Universal Application form for Financial Services authorisation




                                                                                    INSTRUMENTS (Section C-see below)
                                                                                    1           2            3           4            5       6   7   8   9   10
ANCILLARY SERVICES
                                               Person responsible for activity
(Section B)
Safekeeping and administration of
financial instruments for the account of
clients, including custodianship and
related services such as cash/collateral
management
Granting credits or loans to an investor to
allow him to carry out a transaction in one
or more financial instruments, where the
firm granting the credit or loan is involved
in the transaction
Advice to undertakings on capital
structure, industrial strategy and related
matters and advice and services relating
to mergers and the purchase of
undertakings
Foreign exchange services where these
are connected to the provision of
investment services
Investment research and financial
analysis or other forms of general
recommendation relating to transactions
in financial instruments
Services related to underwriting
Investment services and activities as well
as ancillary services of the type included
under Section A or this Section related to
the underlying of the derivatives included
under Section C - 5, 6, 7 and 10 - where
these are connected to the provision of
investment or ancillary services




                                                                                                           13
                                                               Universal Application form for Financial Services authorisation



OTHER PERMISSIONS                                                                               Person responsible for activity
Holding customer money
Holding customer assets
Controlling customer monies
Controlling customer assets
Stock lending
Entering into repurchasing agreements


SECTION C - Instruments
1     Transferable securities
2     Money-market instruments
3     Units in collective investment undertakings
4     Options, futures, swaps, forward rate agreements and any other derivative contracts relating to securities, currencies, interest rates or yields, or other derivatives
      instruments, financial indices or financial measures which may be settled physically or in cash
5     Options, futures, swaps, forward rate agreements and any other derivative contracts relating to commodities that must be settled in cash or may be settled in cash at
      the option of one of the parties (otherwise than by reason of a default or other termination event)
6     Options, futures, swaps, and any other derivative contract relating to commodities that can be physically settled provided that they are traded on a regulated market
      and/or an MTF
7     Options, futures, swaps, forwards and any other derivative contracts relating to commodities, that can be physically settled not otherwise mentioned in C.6 and not
      being for commercial purposes, which have the characteristics of other derivative financial instruments, having regard to whether, inter alia, they are cleared and
      settled through recognised clearing houses or are subject to regular margin call
8     Derivative instruments for the transfer of credit risk
9     Financial contracts for differences
10    Options, futures, swaps, forward rate agreements and any other derivative contracts relating to climatic variables, freight rates, emission allowances or inflation rates
      or other official economic statistics that must be settled in cash or may be settled in cash at the option of one of the parties (otherwise than by reason of a default or
      other termination event), as well as any other derivative contracts relating to assets, rights, obligations, indices and measures not otherwise mentioned in this
      Section, which have the characteristics of other derivative financial instruments, having regard to whether, inter alia, they are traded on a regulated market or an
      MTF, are cleared and settled through recognised clearing houses or are subject to regular margin calls




                                                                                              14
5   The Applicant warrants and undertakes:

    (i)     that having made all reasonable enquiries, the information supplied to the FSC in
            connection with this application is, to the best of its knowledge and belief, accurate in all
            material respects and does not omit any information which might reasonably be
            considered relevant to the application;
    (ii)    that on authorisation, no kind of financial services business other than that disclosed in
            the application or licensed under the Supervisory Acts will be carried on by the
            Applicant unless it is an authorised or exempted person in respect of that business;
    (iii)   that the Applicant will notify the FSC of any material change in the information supplied
            in the application which occurs during the period in which the application for
            authorisation is being considered and that thereafter it will comply with its Obligations
            as regards notification of changes.
    The Applicant authorises the FSC to make such enquiries as it may consider necessary in
    connection with this application.


            Dated                        dd/mm/yy
            Signed




            Position


            Signed




            Position


            Signed




            Position




            For and on behalf of (name of the applicant);
                          Universal Application form for Financial Services authorisation




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 www.fsc.gi/forms/datarequest.htm. 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
         E-Mail info@gra.gi
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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