Universal Application Form
Body Corporate Questionnaire
Notes on Completion
This form should only be completed where;

a controller or shareholder

a director

a manager, or

a partner
of the applicant firm is itself a body corporate.
NB: The term “Controller” is used throughout this form in respect of any or all of the above.
Name of Firm to which this form applies
Date Received
FSC Use Only
Data inputted by
Verified by
Requested by :
Date Requested
Date Completed
Date:
Other Regulator(s)
No
Yes
Referee(s)
No
Yes
Previous Employer(s)
No
Yes
Open Source checks
No
Yes
Professional Bodies
No
Yes
GFIU
No
Yes
Other :
NOTE: All sections must be completed on a "stand-alone" basis which can be supplemented
by (but not replaced with) cross references to additional documents. In these cases, the
relevant document, page and paragraph number should be clearly indicated in the
appropriate section of the form.
Date of Revision: 1 Dec 2014
Universal Application form for Financial Services authorisation
About the Body Corporate
2.1 Name of Body Corporate (Corporate)
2.2 Has the corporate been known by any other names, does it have use over trading
names or does it intend to use any trading names?
No
Yes  Please give details
Name
Date name is effective
dd/mm/yy
dd/mm/yy
dd/mm/yy
dd/mm/yy
2.3 Principal place of business of corporate
Address
Phone number
Fax number
Email address
2.4
Registered office address (if applicable)
Not applicable
Tick if same as 2.3
Address
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Universal Application form for Financial Services authorisation
2.5 Head office address (if applicable)
Not applicable
Tick if same as 2.3
Tick if same as 2.4
Address
2.6 Address in Gibraltar for the service of any notice or other document on the
corporate.
Tick if same as 2.3
Tick if same as 2.4
Tick if same as 2.5
Address
Details of person upon whom notices can be served.
Title
First names
Surname
Job title
Phone number
Fax number
Email address
2.7 Website Address
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Universal Application form for Financial Services authorisation
About the legal status of the corporate
2.8
Legal status of the applicant
Public limited company
Private limited company
Other
2.9
Date of incorporation or formation
Day
Month
Year
2.10
Place of incorporation or formation
Town/city
Country
2.11
Registered number (if any)
2.12
Attach a copy of the Certificate of Incorporation of the Applicant (if any)
Certificate of Incorporation of the Applicant attached to application.
Memorandum & Articles of Association
2.13
Does the Memorandum and Articles of Association prohibit the issue of bearer instruments?
Yes
No, please provide details.
2.14
Does the Memorandum and Articles of Association prohibit or inhibit co-operation with any
authorities whether they be in Gibraltar or elsewhere?
No
Yes, please provide details.
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Universal Application form for Financial Services authorisation
Disclosure of Significant Events
NOTE : For this section the “applicant” should be interpreted as including group or subsidiary
entities connected to the applicant as well as the applicant itself.
Significant events
3.1 Does the corporate hold, or has it ever held, any authority from a supervisory body to carry on
any business in Gibraltar or elsewhere? If so, give particulars. If any such authority was
revoked, give particulars.
No
Yes
3.2 Has the corporate ever applied for any authority form a supervisory body to carry on business in
Gibraltar or elsewhere other than an authority already mentioned in answer to question 3.1. If so,
give particulars. If any such application was, for any reason, refused or withdrawn after it was
made, give particulars.
No
Yes
3.3 Has the corporate within the last 10 years failed to satisfy a judgement debt under a court order
in Gibraltar or elsewhere within a year of the making of the order? If so, give particulars.
No
Yes
3.4 Has the corporate made any compromise or arrangement with its creditors within the last 10
years or otherwise failed to satisfy creditors in full? If so, give particulars.
No
Yes
3.5 Has a receiver or an administrative receiver of any property of the corporate been appointed in
Gibraltar, or has the substantial equivalent of any such person been appointed in any other
jurisdiction, in the last 10 years? If so, give particulars, including whether the receiver or
equivalent is still acting under the appointment.
No
Yes
3.6 Has a petition been serviced in Gibraltar for an administration order in relation to the corporate,
or has the substantial equivalent of such petition been served in any other jurisdiction, in the
last 10 years? If so, give particulars.
No
Yes
3.7 Has a notice of resolution for the voluntary liquidation of the corporate been given in Gibraltar,
or has the substantial equivalent of such a notice been given in any other jurisdiction, in the last
10 years? If so, give particulars.
No
Yes
3.8 Has a petition been served in Gibraltar or elsewhere for the compulsory liquidation of the
corporate, or has the substantial equivalent of such a petition been served in any other
jurisdiction, in the last 10 years? If so, give particulars.
No
Yes
3.9 Is an inspector or other authorised officer of any government department or agency,
professional association or other regulatory body appointed under any Gibraltar or oversees
enactment investigating, or has such an investigation ever previously taken place into, the
affairs of the corporate? If so, give particulars.
No
Yes
3.10 Has the corporate ever been censured, prosecuted, warned as to future conduct, disciplined or
publicly criticised by, or made the subject of a court order at the investigation of, any regulatory
authority in Gibraltar or elsewhere? If so, give particulars.
No
Yes
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Universal Application form for Financial Services authorisation
3.11 Has the corporate ever been refused entry, in Gibraltar or elsewhere, to any professional body
or trade association concerned with banking or financial activities or decided not to apply for
entry after making an approach? If so, give particulars.
No
Yes
3.12 Is the corporate engaged, or does it expect to be engaged, in Gibraltar or elsewhere in any
litigation which may have material effect on the resources of the controller or the firm? If so,
give particulars.
No
Yes
Explanations
3.13 If the answer to any of questions 3.1 to 3.12 is Yes, please give a full explanation of the events in
question on a separate sheet of paper.
Make sure you include:
• the question number the event refers to;
• the date of the event;
• any amounts involved;
• the outcome; and
• an explanation of the circumstances.
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Universal Application form for Financial Services authorisation
Owners and Influencers
Controllers
4.1 Please give details of the controllers (of the body corporate to which this form relates)
below.
1 to 7 controllers – please give details of the controllers below
More than 7 controllers
If the ownership structure has more than seven controllers or is too complicated to show the nature
of the relationship between the firm and each of the controllers (of the body corporate to which this
form relates) from the details below, please provide a structure chart on a separate sheet of paper.
The structure chart should show the nature of the relationship between the firm and each of its
controllers (of the body corporate to which this form relates). It must also include the information
asked for below.
Structure chart provided on separate sheet.
Name
Legal
status of
controller
Direct Holding
Indirect Holding
Number of
Shares
Number of
Shares
Voting
Rights
Voting
Rights
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
4.2
Are any of these voting rights (exercised directly or indirectly) held through a trust?
No
Yes, please provide details.
4.3
Is the corporate engaged, or does it expect to be engaged, in any transactions or arrangements
(excluding receipt of dividends) with the firm? If so, give particulars.
No
Yes, please provide details.
4.4
Is any business of the corporate guaranteed or otherwise underwritten or secured, or expected
to be guaranteed or underwritten or secured, by the firm, for example, by the giving of security
to a bank in respect of lending to the corporate /group company? If so, give particulars.
No
Yes, please provide details.
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Universal Application form for Financial Services authorisation
4.5
Is any business of the corporate guaranteed or otherwise underwritten or secured, or expected
to be guaranteed or underwritten or secured, by the firm, for example, by the giving of security
to a bank in respect of lending to the controller/group company? If so, give particulars.
No
Yes, please provide details.
4.6
How many shares in the firm are registered in the name of the corporate or an associate? Give
name(s) in which registered and class of shares.
4.7
In how many shares in the firm (not being registered in the name of the corporate or an
associate) is the corporate or any company in the same group or any related party beneficially
interested?
4.8
Are any of the shares in the firm mentioned in answer to questions 4.6 and 4.7 equitably or
legally charged or pledged to any part? If so, give particulars.
No
Yes, please provide details.
4.9
Please provide audited accounts for the corporate (and, where appropriate, audited group
accounts for the corporate’s group) for the last three financial years (if available). If the most
recent audited accounts are more than six months out of date, they should be accompanied by
management accounts (which need not be audited) showing the current financial position and
the current results of the controller.
Audited Accounts of the corporate attached to application.
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Universal Application form for Financial Services authorisation
The corporate warrants and undertakes:
I/We certify that the above information supplied in answer to the questions above and those
provided in the attached sheet(s) are accurate and correct to the best of my/our knowledge.
I/We undertake to inform the Financial Services Commission of any changes material to this
declaration which may arise.
Dated
dd/mm/yy
Signed
Position
Signed
Position
Signed
Position
For and on behalf of (name of the applicant);
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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 website 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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