APPLICATION FORMS AND NOTICES (AFN) – DNF1 (For DFSA use only) Form DNF1 Designated Non-Financial Business or Profession (DNFBP) Registration Form Name of DNFBP 1 of 11 DNF1/VER2/07-13 APPLICATION FORMS AND NOTICES (AFN) – DNF1 Purpose of this form This form must be submitted by a DNFBP in order to register with the DFSA to carry on its business activity in or from the DIFC. A registration notice must be submitted in relation any of the DNFBP types contained in section 2. In some cases, the DFSA may require additional information in order to complete the processing of this application. If this is necessary, the DFSA will contact the DNFBP’s nominated person identified in section 1 and/or section 3. Contents This form consists of seven sections: 1. 2. 3. 4. 5. 6. DNFBP details Type of DNFBP Anti Money Laundering Declaration Applicable Fees 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. You should read and be familiar with the AML module (AML) of the DFSA Rulebook. All relevant sections must be completed. Questions must be fully answered and the use of abbreviations should be avoided. Do not leave any questions blank – 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 DNFBP’s senior management. Please ensure any supporting documentation is clearly labelled and securely attached. 2 of 11 DNF1/VER2/07-13 APPLICATION FORMS AND NOTICES (AFN) – DNF1 SECTION 1 - DNFBP DETAILS 1.1 Full or proposed name of the DNFBP 1.2 Registered office in DIFC (Please indicate if current or proposed) 1.3 Main telephone number of address in 1.2 (incl. country and area codes) 1.4 Main fax number of address in 1.2 (incl. country and area codes) 1.5 Head office if different from 1.2 1.6 Head office telephone number of address in 1.5 1.7 Head office fax number of address in 1.5 1.8 Website address 1.9 DNFBP’s contact person for this form Position/title Correspondence address (if different from 1.2 above) Telephone number Mobile number E-mail address 3 of 11 DNF1/VER2/07-13 APPLICATION FORMS AND NOTICES (AFN) – DNF1 1.10 Legal nature of DNFBP (e.g. Company, LLP, Partnership, etc) 1.11 Date and place of incorporation /formation of the DNFBP Note: Please attach a copy of the DNFBP’s certificate of incorporation/company registration (if applicable). If in the process of being formed, please state “in formation”. 1.12 The DNFBP’s expected end of financial year date 4 of 11 DNF1/VER2/07-13 APPLICATION FORMS AND NOTICES (AFN) – DNF1 SECTION 2 - Type of Designated Non-Financial Business or Profession 2.1 Please select the type of Designated Non-Financial Business or Profession (as defined in AML): Real estate developer or agency which carries out transactions with a customer involving the buying or selling of real property Dealer in precious metals or precious stones Dealer in any saleable item of a price equal to or greater than $15,000 Law firm, notary firm, or other independent legal business Accounting firm, audit firm or insolvency firm Company Service Provider Single Family Office 2.2 If applying for the activity of Law firm, notary firm, or other independent legal business, have you been granted a Ruler’s Court Licence? Yes No If “YES”, please attach a copy along with an English translation. If “NO”, please note that before submitting this registration form any DNFBP which proposes to carry on legal services must be appropriately licensed by the Dubai Ruler’s Court. 5 of 11 DNF1/VER2/07-13 APPLICATION FORMS AND NOTICES (AFN) – DNF1 SECTION 3 - ANTI MONEY LAUNDERING 3.1 Money Laundering Reporting Officer (MLRO) (not applicable to a DNFBP which is a dealer in precious metals or precious stones or a dealer in any saleable item of a price equal to or greater than $15,000) 3.1.1 Full Name of MLRO (as stated in passport) 3.1.2 Date of birth (DD/MM/YYYY) 3.1.3 Place of birth 3.1.4 Passport number 3.1.5 Please state the country and place of issue of the MLRO’s passport Please attach a copy of the current passport held by the MLRO, and a copy of their current visa. 3.1.6 Job title/level within the firm 3.1.7 Please confirm the MLRO will ordinarily reside in the UAE 3.1.8 Residential address 3.1.9 Contact details Yes No Telephone Mobile E-mail 6 of 11 DNF1/VER2/07-13 APPLICATION FORMS AND NOTICES (AFN) – DNF1 3.1.10 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. 3.2 AML Policies and Procedures, systems and controls Please attach the DNFBP’s Anti Money Laundering policies, procedures, systems and controls, which must be specific to its DIFC activities and comply with the AML module of the DFSA. These policies, procedures, systems and controls should include, amongst other things, arrangements to: a) Ensure senior management of the Relevant Person is aware of their responsibility for the Relevant Person’s compliance with the AML module, and the duty to exercise due skill, care and diligence in carrying out these responsibilities; b) Comply with the UAE Federal Law No.4 of 2002 and any other relevant UAE Federal laws; c) Monitor for, detect and report suspicious activities, customers and transactions; Note: Applicants should ensure the procedures include a requirement to comply with the Rules for the making of Suspicious Activity Reports (SARs) in the correct format to the Anti Money Laundering Suspicious Cases Unit (AMLSCU) of the UAE Central Bank, and the DFSA being immediately notified that a report has been made. Details of the required format of the report and details for submission can be found on the DFSA website; d) Conduct risk assessments of its business and customers, the finding of which should be used to inform and determine the appropriate level of Customer Due Diligence; e) Review the effectiveness of its anti money laundering policies, procedures, systems and controls at periodic intervals; f) Where relevant, establish and maintain systems and controls to obtain and make appropriate use of relevant resolutions or sanctions issued by the United Nations Security Council; g) Where relevant, establish and maintain systems and controls to obtain and make appropriate use of any findings, recommendations, guidance, directives, resolutions, sanctions, notices or other conclusions issued by government of the of UAE, Central Bank of UAE, Financial Action Task Force, UAE enforcement agencies and the DFSA; h) Assess its risks in relation to money laundering and to perform enhanced due diligence investigations as appropriate in light of the risks; i) Establish and maintain an AML training and awareness programme; and j) Ensure compliance with any other obligation in the DFSA's AML module. 7 of 11 DNF1/VER2/07-13 APPLICATION FORMS AND NOTICES (AFN) – DNF1 3.3 MLRO Declaration 3.3.1 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 8 of 11 DNF1/VER2/07-13 APPLICATION FORMS AND NOTICES (AFN) – DNF1 SECTION 4 - DECLARATION 4.1 Declaration by the firm 4.1.1 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. 4.1.2 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. 4.1.3 I declare that the above-named DNFBP has taken steps to ensure its Employees understand and are aware of the requirement and obligations contained in the AML module. 4.1.5 I confirm that I have the authority to make this registration, 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. 4.1.6 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 / Date 9 of 11 DNF1/VER2/07-13 APPLICATION FORMS AND NOTICES (AFN) – DNF1 7. Fees Details of the 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 Dubai Financial Services Authority Account number 020-683751-100 IBAN AE080200000020683751100 Bank details HSBC Bank Middle East PO Box 66 Dubai, UAE Swift code BBMEAEAD Reference to be quoted Application fee – [applicant name] 10 of 11 DNF1/VER2/07-13 APPLICATION FORMS AND NOTICES (AFN) – DNF1 SECTION 6 - ATTACHMENTS Section Document Attached 1.11 Certificate of Incorporation/Company Registration 2.2 Approval from Ruler’s Court of Dubai (if applicable) – copy of Licence 3.1.5 Copy of passport 3.2 Anti Money Laundering policies and procedures Other Please list Please return completed form to: DUBAI FINANCIAL SERVICES AUTHORITY AUTHORISATION DEPARTMENT LEVEL 13, THE GATE BUILDING DUBAI INTERNATIONAL FINANCIAL CENTRE PO BOX 75850 DUBAI, UAE 11 of 11 DNF1/VER2/07-13