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 either acting as a Fund Manager of an Exempt Fund,
Operating a Representative Office or Operating a Credit Rating Agency.
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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APPLICATION FORMS AND NOTICES (AFN) – AUT-CORE
SECTION 1: DECLARATIONS
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
applicant*
Date
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.
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APPLICATION FORMS AND NOTICES (AFN) – AUT-CORE
SECTION 2: 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
*LTI
** PSIA
Rights under a LTI
Contract*
Structured Products
Futures
Units
Options
Certificates
Proposed Financial Services Activities
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
18. Operating a Credit Rating Agency
Warrants
Please complete the matrix below indicating the Financial Services you propose to
undertake in respect to each Investment or financial product as applicable.
Debentures
CF6.
Shares
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.
Credit
CF5.
Long Term Insurance Contract
Profit Sharing Investment Account
Please note that, if the applicant is a branch of a non-DIFC entity, it may only apply for financial service activities
for which its head office has already been licensed by its home state regulator.
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APPLICATION FORMS AND NOTICES (AFN) – AUT-CORE
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?
CF8.
Yes
No
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.
CF17. Would you like us to copy in your adviser on any correspondence?
Yes
No
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APPLICATION FORMS AND NOTICES (AFN) – AUT-CORE
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 DIFC entity 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
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.
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APPLICATION FORMS AND NOTICES (AFN) – AUT-CORE
Please note if you are a start-up entity, you should attach all the supporting documents below
before the DFSA will accept the application.
Document
All applicants
CF32. Compliance Manual
CF33. Anti-Money
Laundering
Procedures
CF34. Compliance
Monitoring
Programme
CF35. Risk Management
Policies
Supporting
documents attached –
Start-Ups
Complete, and ready to be inspected
Yes
No
Complete and ready to be inspected
Yes
No
Complete and ready to be inspected
Yes
No
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
Account number
IBAN number
Bank details
Swift code
Reference to be quoted
Dubai Financial Services Authority
020-683751-100
AE080200000020683751100
HSBC Bank Middle East
PO Box 66
Dubai, UAE
BBMEAEAD
Application fee – [applicant name]
SECTION 3: 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 4: 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.
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APPLICATION FORMS AND NOTICES (AFN) – AUT-CORE
SECTION 5: FIT AND PROPER QUESTIONNAIRE
Please note: If the answer to any of the following questions is yes, please provide details, attaching
separate sheets/documentation as necessary.
CF39. Have you or any member of your Group been made aware
(whether formally or informally) that you are the subject of
a current or pending investigation, review or disciplinary
procedures by any regulatory authority, professional body,
Financial Services Regulator, self-regulatory organisation,
Authorised Market Institution or regulated exchange or
clearing house, government body or agency or any other
officially appointed inquiry.
Yes
No
Have you or any member of your Group in the last 10 years:
CF40. Been convicted or found guilty by any court of a competent
jurisdiction of any offence?
CF41. Been the subject of disciplinary procedures by a
government body or agency or any self-regulatory
organisation or other professional body?
CF42. 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
Market Institution or regulated exchange or clearing
house?
CF43. Been refused or had a restriction placed on the right to
carry on a trade, business or profession requiring a
licence, registration or other permission?
CF44. 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
$10,000 or awards that total more than $10,000?
CF45. Been censured, disciplined, publicly criticised or the
subject of any investigation or enquiry by any regulatory
authority, Financial Services Regulator or officially
appointed inquiry?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
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.
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APPLICATION FORMS AND NOTICES (AFN) – AUT-CORE
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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