APPLICATION FORMS AND NOTICES (AFN) – DNF2 (For DFSA use only) Form DNF2 Designated Non-Financial Business or Profession (DNFBP) Changes to registration details Name of DNFBP DFSA registration number 1 of 6 DNF2/VER1/07-13 APPLICATION FORMS AND NOTICES (AFN) – DNF2 Purpose of this form This form must be used by a DNFBP to notify the DFSA of any changes in its name, legal status, address or, if applicable, its MLRO. The DFSA may require additional information in order to finalise the processing of this notification. Contents This form consists of five sections: 1. 2. 3. 4. 5. Declaration Summary of changes Changes to DNFBP details Changes to MLRO Attachments Notes for completing this form Defined terms are identified throughout this form by the capitalisation of the initial letter of a word or phrase and are defined in the AML Module of the DFSA’s Rulebook. Some of the defined terms and abbreviations may also be found in the Glossary Module of the DFSA Rulebook. Please fill in the section(s) relevant to the change(s) of your firm. Questions must be fully answered and the use of abbreviations should be avoided. Do not leave any questions blank in the relevant section of change(s) – if a question is not applicable this should be indicated in the response section. Answers must be typed and the form must be signed by a Director/Partner, or a member of the DNFBPs senior management. Please ensure any supporting documentation is clearly labelled and securely attached. Please return completed form to: DUBAI FINANCIAL SERVICES AUTHORITY SUPERVISION DEPARTMENT LEVEL 13, THE GATE BUILDING DUBAI INTERNATIONAL FINANCIAL CENTRE PO BOX 75850 DUBAI, UAE 2 of 6 DNF2/VER2/03-15 APPLICATION FORMS AND NOTICES (AFN) – DNF2 SECTION 1 - DECLARATIONS 1.1 Declaration by the firm 1.1.1 I declare that, to the best of my knowledge and belief, having made due enquiry, the information given in this form 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. 1.1.2 I agree to provide the DSFA with further or more detailed information upon request where the DFSA considers such information necessary to process this registration. 1.1.3 I confirm that I have the authority to make this notification, to declare as specified above and sign this form for, or on behalf of, the DNFBP. I also confirm that I have the authority to give the consent specified above. 1.1.4 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. Name of a Director/Partner / Signature of a Director/Partner 1.2 / Date MLRO Declaration 1.2.1 I declare that, I have read and understood the AML Module of the DFSA Rulebook and am aware of the obligations and requirements I must adhere to as a MLRO. Name of MLRO / Signature of MLRO / Date 3 of 6 DNF2/VER2/03-15 APPLICATION FORMS AND NOTICES (AFN) – DNF2 SECTION 2 - SUMMARY OF CHANGES 2.1 Please indicate the changes you wish to make to your firm details: Change of DNFBP Name complete section 3.1 Change of Registered Office address complete section 3.2 Change of Head Office address complete section 3.3 Change of Legal Status complete section 3.4 Change of Financial Year End complete section 3.5 Money Laundering Reporting Officer complete section 4 SECTION 3 - CHANGES TO DNFBP DETAILS 3.1 Change of DNFBP Name 3.2 Change of Registered Office in DIFC 3.3 Change of Head Office address 3.4 Change of Legal Status* (e.g. limited to unlimited, llc, etc) 3.5 Change of Financial Year End [* Note – where a firm’s DNFBP activities are being transferred to a separate or new legal entity, a new application for registration will be required by the new entity, using Form DNFBP1] 4 of 6 DNF2/VER2/03-15 APPLICATION FORMS AND NOTICES (AFN) – DNF2 SECTION 4 - CHANGE OF MONEY LAUNDERING REPORTING OFFICER (MLRO) 4.1 Money Laundering Reporting Officer 4.1.1 Full Name of MLRO [as stated in passport] 4.1.2 Date of birth (DD/MM/YYYY) 4.1.3 Place of birth 4.1.4 Passport number 4.1.5 Please state the country and place of issue of the applicant’s passport Please attach a copy of the current passport held by the MLRO, and a copy of their current visa. 4.1.6 Job title/level within the firm 4.1.7 Please confirm the MLRO will ordinarily reside in the UAE 4.1.8 Residential address: 4.1.9 Contact details Yes No Telephone Mobile E-mail 4.1.10 What steps has the DNFBP taken to ensure that the MLRO is capable and suitably qualified to undertake the roles and responsibilities as set out in AML Module of the DFSA Rulebook. Please provide details. 5 of 6 DNF2/VER2/03-15 APPLICATION FORMS AND NOTICES (AFN) – DNF2 SECTION 5 - ATTACHMENTS Section Document 4.1.5 Copy of passport Other Please list Attached 6 of 6 DNF2/VER2/03-15