PSD Agent Form - Download Now DOC by malj

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									PAYMENT SERVICES
Add a PSD agent form
Application under regulation 29 of The Payment Services Regulations
2009



 Firm name (i.e. name of
                                   AN Express Ltd ("the firm")
 Payment Institution)

 Firm reference number (FRN)       504626

 Address                           208A Whitechapel Road
                                   London E1 1BJ




Please return the form to:
Permissions Department
The Financial Services Authority
25 The North Colonnade
Canary Wharf
London
E14 5HS




Version 1.0 - April 2009                    Page 1 of 9
 Notes

This form should only be used to notify us of an agent of a Small Payment Institution or an Authorised Payment
Institution. It is the responsibility of the Payment Institution to complete and submit this form on behalf of its
Agents.


  Personal details                                                                                Section A


       Contact name at the Payment Institution (this is not        Abdul Ullah
 1     necessarily the same person making the declaration at the
       end of the form)


 2     Contact's details:


                                                                   Managing Director
       a     position in the firm


                                                                   020 7377 9865
       b     daytime telephone number


                                                                   abdul@angroup.co.uk
       c     email address

                                                                   N/A
       d     individual reference number (IRN), if applicable




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  Agent details                                                                                       Section B


 1     Name

       If the agent is on the FSA Register please provide their firm
 2
       reference number (FRN)

 3     Address (include country if not UK)




                                                                                              Postcode:


 4     Trading name(s), if different to the name given in question 1
       above



 5     Telephone number

 6     Fax number

 7     Email address

 8     Website address (not mandatory)

 9     Legal status


       Private limited company                                               Public limited company


       Partnership                                                           Limited partnership


       Limited liability partnership                                         Unincorporated association


       Sole trader                                                           Other, please specify below

       Authorised Payment Institutions only

 10    Will the Authorised Payment Institution be      Yes        No
       engaging the agent to provide payment
       services in another EEA State(s)?

       If „no‟, proceed to Section C. If „yes‟, we will link this agent to
       the “right to establish” passports held by the Authorised Payment
       Institution for any EEA State given in the Agent address above. If
       this agent will have an establishment in, or provide services into,
       any other EEA State you will need to supply this information on a
       separate sheet of paper, specifying for each EEA State:

       -    whether the agent will have an establishment or will provide
            cross-border services; and

       -    the payment services that will be provided.




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 Notes

Firms wishing to appoint agents need to provide a description of the internal control mechanisms that will be used
by the agent to comply with money laundering legislation. For more information on the type of money laundering
controls we expect to see being used by firms and their agents, please refer to Chapter 3 of the Approach
Document.

   Money laundering controls                                                                      Section C


                                                                                                      Yes      No

 1 Has the firm already supplied to us, as part of another application, a description of the
   money laundering controls that will be used by all their agents, and do you confirm that
   those controls will be used by this agent?



     If „yes‟, proceed to Section D.
     If „no‟, please provide a description of the internal money laundering controls to be used by this agent to
     comply with money laundering legislation.




    Directors/persons responsible for payment services                                           Section D

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                                                                                                         Yes   No
 1 Is the applicant an agent of an Authorised Payment Institution?

     If „yes‟, please complete the following table for the proprietor, director(s)/partner(s) and
     person(s) responsible for the management of the agent.
     Please state number of individuals

             Full name of            National Insurance       Date of       Assessed        Anything
        individual(s) – include        (NI) number, or         birth          as a        to disclose
         previous name(s), if         passport number                        fit and       in relation
       applicable and date(s) of      and nationality if                     proper       to Annex 1
       name change(s) and any         NI number is not                       person
          Name(s) commonly                available
              known by
                                                                            Yes   No       Yes      No



                                                            dd/mm/yy




                                                            dd/mm/yy




                                                            dd/mm/yy




                                                            dd/mm/yy




                                                            dd/mm/yy




     If there is not enough space above, please continue on a separate sheet of paper and attach it
     to the form.

 2 If the firm has anything to disclose for any individual, whether in relation to Annex 1 or
   otherwise, please provide further information on a separate sheet of paper, clearly
   identifying the individual(s) it relates to.


 Notes

     Please see Annex 1 for the questions that we expect you to ask of each of the above individual(s) to assess
     their fitness and propriety. This list is not exhaustive and you should advise individual(s) to disclose to you
     any issues that could affect their fitness and propriety.




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    Declaration and signature                                                                        Section E

 Warning
 Knowingly or recklessly giving the FSA information, which is false or misleading in a material particular, may
 be a criminal offence (regulation 114 of The Payment Services Regulations 2009) and may lead to disciplinary
 sanctions or other enforcement action by the FSA.
 It should not be assumed that information is known to the FSA merely because it is in the public domain or has
 previously been disclosed to the FSA or another regulatory body. If you are not sure whether a piece of
 information is relevant, please include it anyway.


 Data protection
 For the purposes of complying with the Data Protection Act 1998, the personal information in this form will be
 used by the FSA to discharge its statutory functions under The Payment Services Regulations 2009 and other
 relevant legislation. It will not be disclosed for any other purposes without the permission of the applicant.


 Declaration
 By submitting this notification:
          I/we confirm that this information is accurate and complete to the best of my knowledge and belief and
           that I have taken all reasonable steps to ensure that this is the case.
          I am/we are aware that it is a criminal offence knowingly or recklessly to give the FSA information
           that is false or misleading in a material particular.
          I am/we are aware that some questions do not require supporting evidence. However, the records,
           which demonstrate the applicant firm's compliance with the requirements in relation to the questions,
           are available to the FSA on request.
          I/we will notify the FSA immediately if there is a significant change to the information given in the
           form. If I/we fail to do so, this may result in a delay in the application process or enforcement action.



 Signature

 Name of signatory

 Date                                              /    /


 Position in firm




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  Annex 1 - Fitness and propriety

 1.01 a             Has the individual ever been convicted of any offence (that is unspent,
                    and whether or not in the UK):
                           i.     involving fraud, theft, false accounting, offences against
                                  the administration of public justice (such as perjury,
                                  perverting the course of justice and intimidation of
                                  witnesses or jurors), serious tax offences or other
                                  dishonesty; or
                           ii.    relating to payment services, companies, building
                                  societies, industrial and provident societies, credit
                                  unions, friendly societies, insurance, banking or other
                                  financial services, insolvency, consumer credit or
                                  consumer protection, money laundering, market
                                  manipulations or insider dealing?


        b           Is the individual the subject of any current criminal proceedings?


 1.02               Has the individual any unspent convictions for any offences (whether
                    or not in the UK) other than those in 1.01 (excluding traffic offences
                    that did not result in a ban from driving or did not involve driving
                    without insurance)?

 1.03 a             Has the individual ever had a County Court Judgment (CCJ) or other
                    judgment debt, (whether or not in the United Kingdom)?
                    Has the individual had:
                    i. more than two CCJs or judgment debts?
                    ii. more than £1,000 in total of CCJs or judgment debts?

        b           Is the individual aware of anybody's intention to:
                    i. begin proceedings against the individual for a CCJ or other judgment
                    debt?
                    ii. begin more than one set of proceedings against the individual for a
                    CCJ or other judgement debt?
                    iii. claim more than £1,000 of CCJs or judgment debts in total from the
                    individual?

 1.04               Does the individual have any judgment debts (including CCJs) made
                    under a court order still outstanding, whether in full or in part?

 1.05               Has the individual ever failed to satisfy any such judgment debts within
                    one year of the making of the order?

 1.06 a             Is the individual, or has the individual ever been, the subject of any
                    bankruptcy proceedings, or proceedings for the sequestration of the
                    individual’s estate?

        b           Has the individual ever entered or is in the process of entering into an
                    agreement in favour of the individual's creditors, for example a deed of
                    arrangement or an individual voluntary arrangement (or in Scotland a
                    trust deed)?
        C

        c           Have any of the above not discharged?




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 1.07               Does the individual have any outstanding financial obligations arising
                    from regulated activities, which the individual has carried on in the past
                    (whether or not in the United Kingdom or overseas)?

                    (In the case of advisers, this will include any outstanding liabilities
                    arising from commissions paid for the sale of packaged products that
                    have lapsed.)



 1.08               Has the individual ever been found guilty of carrying on any
                    unauthorised regulated activities, or been investigated for the possible
                    carrying on of unauthorised regulated activities?

 1.09               Is the individual, or has the individual ever been, the subject of an
                    investigation into allegations of misconduct or malpractice in
                    connection with any business activity?

 1.10               Has the individual ever (whether or not in the United Kingdom):

        a              been refused entry to, or been dismissed, suspended or requested
                       to resign from, any profession, vocation, office or employment, or
                       from any fiduciary office or position of trust, whether or not
                       remunerated?

        b              been refused, restricted in, or had suspended, the right to carry on
                       any trade, business or profession for which specific licence,
                       authorisation, registration, membership or other permission is
                       required?

        c              been disqualified from acting as a director of a company, or from
                       acting in a management capacity, or conducting the affairs of any
                       company, partnership or unincorporated association?

        d              been the subject of a disqualification direction under section 59 of
                       the Financial Services Act 1986 or a prohibition order, under
                       section 56 of the Financial Services and Markets Act 2000, or
                       received a warning notice that such a direction or order be made?

 1.11               In relation to activities regulated by the FSA or another regulatory body
                    (see note section 5), has:
                    i. the individual or
                    ii. any company, partnership or unincorporated association of which
                    the individual is or has been a controller, director, senior manager,
                    partner or company secretary, during the individual’s association with
                    that entity and for a period of three years after the individual ceased to
                    be associated with it, ever:

        a              been refused, had revoked, restricted or terminated, any licence,
                       authorisation, registration, notification, membership or other
                       permission granted by any such body?

        b              been criticised, censured, disciplined, suspended, expelled, fined,
                       or been the subject of any other disciplinary or intervention action
                       by any such body?

        c              resigned while under investigation by, or been required to resign
                       from, any such body?

        d              decided, after making an application for any licence, authorisation,
                       registration, notification, membership or other permission granted
                       by any such body, not to proceed with it?

        e              been the subject of any civil action, which has resulted in a finding
                       against the candidate or it by a court?




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 1.12       Has any company, partnership, or unincorporated association of which the
            individual is or has been a controller, director, senior manager, partner, or
            company secretary, in the United Kingdom or elsewhere, at any time during
            the individual’s involvement or within one year of such an involvement:

        a       been put into liquidation, wound up, ceased trading, had a receiver or
                administrator appointed or entered into any voluntary arrangement with its
                creditors?

        b       been adjudged by a court liable for any fraud, misfeasance, wrongful
                trading or other misconduct?

        c       been investigated or been involved in an investigation by an inspector
                appointed under companies or any other legislation, or required to produce
                documents to the Secretary of State, or any other authority, under any such
                legislation?

        d       been convicted of any criminal offence, censured, disciplined or publicly
                criticised, by any inquiry, by the Takeover Panel or any governmental or
                statutory authority or any other regulatory body (other than as already
                indicated under 1.11(b))?

 1.13       Is the individual aware of any business interests, employment obligations, or
            any other situations, which may conflict with the performance of the position
            for which approval is now sought?




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