Long Form A Dual-regulated firms (including EEA and third country firms)

Transcription

1 Applition numer (for FCA/PRA use only) The FCA hs proue notes whih will ssist oth the pplint firm n the nite in nswering the questions in this form. Plese re these notes, whih re ville on oth the FCA n PRA wesites t: Both the pplint firm n the nite will e trete y the FCA n PRA s hving tken these notes into onsiertion when ompleting this form. Terms efine in either or oth of the FCA Hnook or the PRA Ruleook re itliise n shoul e onstrue oringly. Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Applition to perform ontrolle funtions inluing senior mngement funtions FCA Hnook Referene: SUP 10C Annex 3D PRA Ruleook Referene: Senior Mngers Regime - Applitions n Notifitions 1 10 Deemer 2018 Nme of nite (to e omplete y pplint firm) Nme of pplint firm (s entere in 2.01) Firm referene numer (s entere in 2.02) Finnil Conut Authority 12 Enevour Squre Strtfor Lonon E20 1JN Unite Kingom Telephone +44 (0) E-mil firm.queries@f.org.uk Wesite Registere s Limite Compny in Engln n Wles No Registere Offie s ove Pruentil Regultion Authority 20 Moorgte Lonon EC2R 6DA Unite Kingom Telephone +44 (0) E-mil PRA- ApprovePersons@nkofengln.o.uk Wesite 1 The relevnt setion of the PRA Ruleook shoul e referre to epening on whih firm is pplying. For exmple: CRR firms: Senior Mngers Regime - Applitions n Notifitions; Non CRR firms: Senior Mngers Regime - Applitions n Notifitions; Solveny II firms: Insurne - Senior Mngers Regime Applitions n Notifitions; Lrge Non-Solveny II firms: Insurne - Senior Mngers Regime Applitions n Notifitions; Non-Solveny II firms: Insurne - Senior Mngers Regime Applitions n Notifitions Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 1

2 Personl ientifition etils Setion Cnite Iniviul Referene Numer (IRN) OR nme of previous regultory oy AND previous referene numer (if pplile) 1.02 Title (e.g. Mr, Mrs, Ms) 1.03 Surnme 1.04 ALL forenmes 1.05 Nme ommonly known y 1.06 Dte of irth (/mm/yyyy) 1.07 Ntionl Insurne numer 1.08 Previous nme 1.09 Dte of nme hnge 1.10 Ntionlity Pssport numer (if Ntionl Insurne numer not ville) 1.11 Ple of irth 1.12 Phone numer 1.13 Emil ress relte to this pge in Setion 6 Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 2

3 1.14 Privte ress Postoe Dtes resient t this ress (/mm/yyyy) From To PRESENT (If ress hs hnge in the lst three yers, plese provie resses for the previous three yers.) 1.15 Previous ress 1 Postoe Dtes resient t this ress (/mm/yyyy) From To 1.16 Previous ress 2 Postoe Dtes resient t this ress (/mm/yyyy) From To relte to this pge in Setion 6 Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 3

4 Firm ientifition etils Setion Nme of firm mking the pplition 2.02 Firm Referene Numer (FRN) 2.03 Who shoul the FCA/PRA ontt t the firm in reltion to this pplition? Position Phone numer E-mil Plese note tht the ontt t the firm nnot e the sme person s the nite relte to this pge in Setion 6 Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 4

5 Arrngement n Senior Mngement Funtions Setion 3A Complete this setion if the pplition is for senior mngement funtion. If you re sumitting n pplition for ontrolle funtion t n ppointe representtive then plese omplete Setion 3B. 3A.01 Nture of the rrngement etween the nite n the pplint firm Employee Group employee Nme of group e Contrt for servies Prtner Other Give etils Propose te of ppointment Length of ppointment (if pplile) 3A.02 For pplitions from single firm, plese tik the oxes tht orrespon to the senior mngement funtions to e performe. If the senior mngement funtions re to e performe for more thn one firm, plese leve the oxes elow lnk n go to question 3A.04 The tle elow sets out the full list of senior mngement funtions (SMFs). Plese refer to the PRA Ruleook n FCA Hnook for the mntory SMFs for your firm. Funtion Desription of Senior Mngement Funtion UK nks* UK rnhes of EEA nks n insurers UK rnhes of non- EEA nks Creit unions Solveny II firms & lrge NDFs Smll NDFs ISPVs Smll firms in run off UK rnhes of non- EEA insurers SMF 1 Chief Exeutive SMF 2 Chief Finne SMF 3 Exeutive Diretor SMF 4 Chief Risk SMF 5 He of Internl Auit SMF 6 He of Key Business Are Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 5

6 Funtion Desription of Senior Mngement Funtion UK nks* UK rnhes of EEA nks n insurers UK rnhes of non- EEA nks Creit unions Solveny II firms & lrge NDFs Smll NDFs ISPVs Smll firms in run off UK rnhes of non- EEA insurers SMF 7 Group Entity Senior Mnger SMF 8 Creit Union Senior Mnger SMF 9 Chir of the Governing Boy SMF10 Chir of the Risk Committee SMF11 Chir of the Auit Committee SMF12 Chir of the Remunertion Committee SMF13 Chir of the Nomintion Committee SMF14 Senior Inepenent Diretor SMF15 Chir of With Profits Committee SMF16 Compline Oversight SMF17 Money Lunering Reporting Offier (MLRO) SMF18 Other Overll Responsiility SMF19 He of Thir Country Brnh/ He of Overses SMF20 Chief Atury SMF20 With-Profits Atury SMF21 EEA Brnh Senior Mnger (EBSM) SMF22 Other Lol Responsiility SMF23 Chief Unerwriting Offier SMF23 Unerwriting Risk Oversight (Lloy s) SMF23 Conut Risk Oversight (Lloy s) Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 6

7 Funtion Desription of Senior Mngement Funtion UK nks* UK rnhes of EEA nks n insurers UK rnhes of non- EEA nks Creit unions Solveny II firms & lrge NDFs Smll NDFs ISPVs Smll firms in run off UK rnhes of non- EEA insurers SMF24 Chief Opertions SMF25 Smll Insurer Senior Mngement Funtion SMF26 He of Smll Run-Off Firm SMF27 Prtner * UK Bnks refers to UK nks, uiling soieties n PRA esignte investment firms 3A.03 Jo title Insurne istriution Will the nite e responsile for insurne istriution t the firm? (Note: Yes n only e selete if the iniviul is pplying for governing funtion (other thn non-exeutive iretor funtion)) Mortgge Creit Diretive Will the nite e responsile for Mortgge Creit Diretive Intermeition t the firm? relte to this pge in Setion 6 Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 7

8 3A.04 Complete this setion only if the pplition is on ehlf of more thn one firm. List ll firms within the group (inluing the firm entere in 2.01) for whih the nite requires pprovl n the requeste senior mngement funtion for tht firm. Firm Referene Numer Nme of firm Senior Mngement Funtion Jo title Responsile for insurne istriution? Responsile for mortgge reit intermeition? Effetive te e relte to this pge in Setion 6 Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 8

9 Arrngements n ontrolle funtions Appointe Representtives Setion 3B Complete this setion if the pplition is for ontrolle funtion t n ppointe representtive (AR). If you re sumitting n pplition for senior mngement funtion, then plese omplete Setion 3A. For limite permission onsumer reit firms tht re lso ppointe representtives, only the ustomer funtion is relevnt in this setion. For these firms, relevnt senior mngement funtions pply inste of the governing funtions (ie CF1 (AR), CF3 (AR), CF4 (AR) n CF5 (AR)). We o not expet this to pply to mny firms. 3B.01 Nture of the rrngement etween the nite n the pplint. Appointe representtive/tie gent ustomer funtion AR firm nme n referene numer Appointe representtive/tie gent governing funtion AR firm nme n referene numer Other Give etils 3B.02 For pplitions from single firm, plese tik the oxes tht orrespon to the ontrolle funtions to e performe. If the ontrolle funtions re to e performe for more thn one firm, plese go to question 3B.05. Signifint influene CF 1 (AR) Diretor funtion funtions CF 3 (AR) Chief exeutive funtion CF 4 (AR) Prtner funtion CF 5 (AR) Diretor of n uninorporte ssoition funtion Senior Mngement Funtions (This setion is only pplile for limite permission onsumer reit firms tht re ARs for other usiness) SMF1 (AR) Chief Exeutive funtion SMF3 (AR) Exeutive Diretor funtion SMF4 (AR) Prtner funtion Customer funtion CF 30 (AR) Customer funtion 3B.03 Effetive te of ontrolle funtions inite ove 3B.04 Jo title Plese refer to notes on the requirements for sumitting CV. relte to this pge in Setion 6 Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 9

10 3B.05 Complete this setion only if the pplition is on ehlf of more thn one firm. List ll firms within the group (inluing the firm entere in 2.01) for whih the nite requires pprovl n the requeste ontrolle funtion for tht firm. Firm Referene Numer Nme of firm Controlle funtion Jo title Effetive te e relte to this pge in Setion 6 Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 10

11 Employment history in the pst 5 yers Setion 4 N.B.: ALL gps must e ounte for 4.01 Employment etils (1) Perio (/mm/yyyy) From To Nture of employment Employe Self-employe Not employe Full-time eution If or is tike, plese give etils Nme of employer Nture of usiness e Previous / other nmes of employer f Lst known ress of employer g Is/ws employer regulte y regultory oy? Nme of regultory oy h Is/ws employer n ppointe representtive/tie gent? If yes, of whih firm? i Position hel j Responsiilities k Reson for leving: Resigntion Reunny Retirement Termintion/ismissl e En of ontrt f Other If other, plese speify Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 11

12 4.02 Employment etils (2) Perio (/mm/yyyy) From To Nture of employment Employe Self-employe Not employe Full-time eution If or is tike, plese give etils Nme of employer Nture of usiness e Previous / other nmes of employer f Lst known ress of employer g Is/ws employer regulte y regultory oy? Nme of regultory oy h Is/ws employer n ppointe representtive/tie gent? If yes, of whih firm? i Position hel j Responsiilities k Reson for leving: Resigntion Reunny Retirement Termintion/ismissl e En of ontrt f Other If other, plese speify relte to this pge in Setion 6 Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 12

13 Fitness n propriety Setion Criminl Proeeings When nswering the questions in this setion the nite shoul inlue mtters whether in the UK or overses. By virtue of the Rehilittion of Offeners At 1974 (Exeptions) Orer 1975, if the nite is sujet to the lw of Engln n Wles, the nite must islose spent onvitions n utions (other thn protete onvition or ution). By virtue of the Rehilittion of Offeners At 1974 (Exlusions n Exeptions) (Sotln) Orer 2013 n the Rehilittion of Offeners (Exeptions) Orer (Northern Ireln) 1979, if the nite is sujet to the lw of Sotln or Northern Ireln, the nite must islose spent onvitions (other thn protete onvition). For the voine of out, referenes to the legisltion ove re referenes to the legisltion s mene. If ny question hs een nswere yes in Setion 5, further etils shoul e provie in Setion 6. If there is ny other informtion the nite or the firm onsiers to e relevnt to the pplition, it must e inlue in Setion Hs the nite ever een onvite of ny riminl offene (whether spent or not n whether or not in the Unite Kingom): i. involving fru, theft, flse ounting, offenes ginst the ministrtion of puli justie (suh s perjury, perverting the ourse of justie n intimition of witnesses or jurors), serious tx offenes or other ishonesty or ii. relting to ompnies, uiling soieties, inustril n provient soieties, reit unions, frienly soieties, insurne, nking or other finnil servies, insolveny, onsumer reit or onsumer protetion, money lunering, mrket mnipultions or insier eling? Is the nite urrently the sujet of ny riminl proeeings, whether in the UK or elsewhere? Hs the nite ever een given ution in reltion to ny riminl offene? Hs the nite ny onvitions for ny offenes other thn those in ove (exluing trffi offenes tht i not result in n from riving or i not involve riving without insurne)? Is the nite the sujet of ny ongoing riminl investigtion? Hs the nite een orere to proue ouments pursunt to ny ongoing riminl investigtion or een the sujet of serh (with or without wrrnt) pursunt to ny ongoing riminl investigtion? In nswering question , you shoul inlue ll mtters even where the nite ws not the sujet of the investigtion. relte to this pge in Setion 6 Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 13

14 Hs ny firm t whih the nite hols or hs hel position of influene ever: (Plese hek the guine notes for the mening of position of influene in the ontext of the questions in this prt of the form.) Been onvite of ny riminl offene? Been summonse, hrge with or otherwise investigte or proseute for ny riminl offene? Been the sujet of ny riminl proeeing whih hs not resulte in onvition? Been orere to proue ouments in reltion to ny riminl investigtion or een the sujet of serh (with or without wrrnt) in reltion to ny riminl investigtion? In nswering question , you shoul inlue ll mtters even when the summons, hrge, proseution or investigtion i not result in onvition, n, in respet of , even where the firm ws not the sujet of the investigtion. However, firms re not require to islose etils of ny speifi iniviuls who were sujet to histori (s oppose to ongoing) riminl investigtions, proseutions, summons or other histori riminl proeeings. relte to this pge in Setion 6 Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 14

15 5.02 Civil Proeeings Hs the nite, ever een the sujet of jugement et or wr ginst the nite (whether stisfie or not)? Plese give full explntion of the events in question, The nite shoul inlue ll County Court Jugement(s) (CCJs) me ginst the nite, whether stisfie or not); n i) the sum n te of ll jugements ets, wrs or CCJs (whether stisfie or not); n ii) the totl numer of ll jugement ets, wrs or CCJs orere Hs the nite ever een prty to ny ivil proeeings whih resulte in ny orer ginst the nite (other thn jugement et or wr referre to in ove)? (the nite shoul inlue, for exmple, injuntions n employment triunl proeeings.) Is the nite wre of: Any proeeings tht hve egun, or nyone s intention to egin proeeings ginst the nite, for CCJ or nother jugement et? More thn one set of proeeings, or nyone s intention to egin more thn one set of proeeings, tht my le to CCJ or other jugement et? Does the nite hve ny urrent jugement ets (inluing CCJs) me uner ourt orer still outstning, whether in full or in prt? Hs the nite ever file to stisfy ny suh jugment ets (inluing CCJs) me uner ourt orer still outstning, whether in full or prt, within one yer of the orer eing me? relte to this pge in Setion 6 Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 15

16 Hs the nite ever: File for the nite s own nkrupty or h nkrupty petition serve on the nite? Been juge nkrupt? Been the sujet of nkrupty restritions orer (inluing n interim nkrupty restritions orer) or offere nkrupty restritions unertking? Me ny rrngements with the nite s reitors, for exmple ee of rrngement or n iniviul voluntry rrngement (or in Sotln trust ee)? e H ssets sequestrte? f Been involve in ny proeeings relting to the ove mtters even if suh proeeings i not result in the mking of ny kin of orer ginst the nite or result in ny kin of greement with the nite? Does the nite, or ny unertking uner their mngement, hve ny outstning finnil oligtions rising from regulte tivities, whih hve een rrie out in the pst (whether or not in the UK or overses)? Hs the nite ever een juge y ourt or triunl (whether riminl, ivil or ministrtive) for ny fru, misfesne, negligene, wrongful tring or other misonut? Or een foun y juge or triunl to hve lie on oth n/or tht their eviene ws to e iselieve? Is the nite urrently: Prty to ny ivil proeeings (inluing those overe in ove)? Awre of nyoy s intention to egin ivil proeeings ginst the nite? (Cnite shoul inlue ny ongoing isputes whether or not suh ispute is likely to result in ny orer ginst the nite.) During the perio over whih the nite hs hel position of influene n/or in the 10 yers fter this, hs ny firm t whih the nite hols or hs hel position of influene ever een: Ajuge y ourt ivilly lile for ny fru, misfesne, wrongful tring or other misonut? The sujet of jugement et or wr ginst the firm? (Cnite shoul inlue ll CCJs me ginst the firm, whether stisfie or not.) Prty to ny other ivil proeeings whih resulte in n orer ginst the firm other thn in reltion to mtters overe in n ove? relte to this pge in Setion 6 Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 16

17 Is ny firm t whih the nite urrently hols or hs hel, within the lst 12 months from the te of the sumission of this form, position of influene urrently: prty to ivil proeeings; n/or wre of nyone s intention to egin ivil proeeings ginst them? Hs ny ompny, prtnership or uninorporte ssoition of whih the nite is or hs een ontroller, iretor, senior mnger, prtner or ompny seretry, in the UK or elsewhere, t ny time uring their involvement, or within one yer of suh n involvement, een put into liquition, woun up, ese tring, h reeiver or ministrtor ppointe or entere into ny voluntry rrngement with its reitors? relte to this pge in Setion 6 Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 17

18 5.03 Business n Employment Mtters Hs the nite ever een: Disqulifie from ting s iretor or similr position (one where the nite ts in mngement pity or onuts the ffirs of ny ompny, prtnership or uninorporte ssoition)? The sujet of ny proeeings of isiplinry nture (whether or not the proeeings resulte in ny fining ginst the nite)? The sujet of ny investigtion whih hs le or might le to isiplinry proeeings? Notifie of ny potentil proeeings of isiplinry nture ginst the nite? e The sujet of n investigtion into llegtions of misonut or mlprtie in onnetion with ny usiness tivity? (This question overs internl investigtion y n uthorise firm, s well s investigtion y regultory oy, t ny time.) Hs the nite ever een refuse entry to, or een ismisse, suspene or requeste to resign from, ny professionl, votion, offie or employment, or from ny fiuiry offie or position of trust whether or not remunerte? Does the nite hve ny mteril written omplints me ginst the nite y the nite s lients or former lients in the lst five yers whih the nite hs epte, or whih re witing etermintion, or hve een uphel y n omusmn or omplints sheme? Hs the nite ever prtiipte in ritrtion proeeings? (This question only pplies where the pplint firm is Solveny II insurne firm). relte to this pge in Setion 6 Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 18

19 5.04 Regultory Mtters In reltion to tivities regulte y the FCA n/or PRA or ny other regultory oy, hs: the nite, or ny ompny, prtnership or uninorporte ssoition of whih the nite is or hs een ontroller, iretor, senior mnger, prtner or ompny seretry, uring the nite s ssoition with the entity n for perio of three yers fter the nite ese to e ssoite with it, ever Been refuse, h revoke, restrite, een suspene from or terminte, ny liene, uthoristions, registrtion, notifition, memership or ny other permission grnte y ny suh oy? Been ritiise, ensure, isipline, suspene, expelle, fine or een the sujet of ny other isiplinry or interventionl tion y ny suh oy? Reeive wrning (whether puli or privte) tht suh isiplinry or interventionl tion my e tken ginst the nite or the firm? Been the sujet of n investigtion y ny regultory oy, whether or not suh n investigtion resulte in fining ginst the nite or the firm? e Been require or requeste to proue ouments or ny other informtion to ny regultory oy in onnetion with suh n investigtion (whether ginst the firm or otherwise)? f Been investigte or een involve in n investigtion y n inspetor ppointe uner ompnies or ny other legisltion, or require to proue ouments to the Seretry of Stte, or ny other uthority, uner ny suh legisltion? g Cese operting or resigne whilst uner investigtion y ny suh oy or een require to ese operting or resign y ny regultory oy? h Deie, fter mking n pplition for ny liene, uthoristion, registrtion, notifition, memership or ny permission grnte y ny suh oy, not to proee with it? i Been the sujet of ny ivil tion relte to ny regulte tivity whih hs resulte in fining y ourt? j Provie pyment servies or istriute or reeeme e-money on ehlf of regulte firm or itself uner ny ontrtul greement where tht greement ws terminte y the regulte firm? k Been onvite of ny riminl offene, ensure, isipline or pulily ritiise y ny inquiry, y the Tkeover Pnel or ny governmentl or sttutory uthority or ny other regultory oy (other thn s inite in this group of questions)? l Been on or of iretors in n operting unertking tht hs not een grnte relese from liility? (This question only pplies where the pplint firm is Solveny II insurne firm). relte to this pge in Setion 6 Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 19

20 In reltion to tivities regulte y the FCA/PRA or ny other regultory oy, hs the nite or ny firm t whih the nite hols or hs hel position of influene t ny time uring n within one yer of the nite s ssoition with the firm ever: Been foun to hve rrie on tivities for whih uthoristion or registrtion y the FCA/PRA or ny other regultory oy is require without the requisite uthoristions? Been investigte for the possile rrying on of tivities requiring uthoristion or registrtion y the FCA/PRA or ny other regultory oy without the requisite uthoristion whether or not suh investigtion resulte in fining ginst the nite? Been foun to hve performe senior mngement funtion or other ontrolle funtion (or n equivlent funtion requiring pprovl y the FCA/PRA or ny other regultory oy) without the requisite pprovl? Been investigte for the possile performne of senior mngement funtion or other ontrolle funtion (or n equivlent funtion requiring pprovl y the FCA/PRA or ny other regultory oy) without the requisite pprovl, whether or not suh investigtion resulte in fining ginst the nite? e Been foun to hve file to omply with n oligtion uner the Eletroni Money Regultions 2011 or Pyment Servies Regultions 2009 to notify the FCA/PRA of the ientity of person ting in position of influene over its eletroni money or pyment servies usiness? f Been the sujet of prohiition orer uner setion 56 of the Finnil Servies n Mrkets At 2000, or reeive wrning notie proposing tht suh iretion or orer e me, or reeive privte wrning? relte to this pge in Setion 6 Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 20

21 5.05 Other Mtters Is the nite, in the role to whih the pplition reltes, wre of ny usiness interests, employment oligtions, or ny other irumstne whih my onflit with the performne of the senior mngement funtions for whih pprovl is now eing sought? Question shoul only e nswere if the pplint firm is Solveny II Insurer. Does the nite hve, or know of ny: Qulifying ownership 2 or ny other form of sustntil influene in the firm or group, or ny other ompnies If yes, plese provie: 1. Compny nme n registrtion numer 2. Nture n sope of the opertions 3. The registere offie of the ompny 4. Possession in perentge Close reltives with ny other finnil reltions in the firm or group Any other ommitments tht my give rise to onflit of interest If the response is yes to ny of the ove, plese provie, in Setion 6, explntions of the irumstnes n how the nite intens to mitigte this Is the nite or the firm wre of ny other informtion relevnt to this notifition tht the FCA/PRA might resonly expet from the nite? Hs the firm unertken riminl reors hek in orne with the requirements of the FCA or PRA? Plese note tht firm is require, uner PRA rules, to request n uner FCA rules, to otin the fullest informtion tht it is lwfully le to otin out the nite uner Prt V of the Polie At 1997 (Certifites of Criminl reors, et) n relte suorinte legisltion of the UK or ny prt of the UK efore mking the pplition (SUP 10C.10 n PRA Ruleook: Fitness n Propriety). 3 If yes, plese enter te the hek ws unertken Dte (/mm/yy): Note: if te is more thn 3 months prior to urrent te or 3 months prior to te of pplition sumission or the hek hs not een unertken, plese provie etils why in Setion Hs / Hve referene or referenes een otine from urrent or previous employer(s) in orne with the requirements of the FCA or PRA? If no, plese provie etils why the referene or referenes hs/hve not een otine. 2 As efine in Artile 13(21) of the Solveny II Diretive, qulifying ownership is iret or iniret holing in n unertking whih represent 10% or more of the pitl or of the voting rights or whih mkes it possile to exerise signifint influene over the mngement of tht unertking. 3 The relevnt setion of the PRA Ruleook shoul e referre to epening on whih firm is pplying. Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 21

22 relte to this pge in Setion 6 Plese note tht firm is require to use resonle steps to otin n pproprite referene from ny urrent or previous employer of the nite uring the lst 6 yers (see SYSC 22 n Fitness n Propriety 2 in the PRA Ruleook). Employer hs n extene mening for these purposes. Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 22

23 Supplementry informtion for Senior Mngement Funtions Setion Plese provie full etils of: ) why the nite is ompetent n ple to rry out the ontrolle funtion(s) pplie for; ) why the ppointment omplements the firm's usiness strtegy, tivity n mrket in whih it opertes; ) how the ppointment ws gree inluing etils of ny isussions t governing oy level (where pplile); ) list of ll iretorships urrently or previously hel y the nite in the pst 10 yers (where iretor hs the mening given in the Glossry); n e) if the nite urrently hols more thn one iretorship, plese provie rekown on the nite s time ommitment to eh iretorship If there is ny itionl informtion inite in previous setions or ny other informtion the nite or the firm onsiers eing relevnt to this pplition it must e inlue here. (Plese lso provie full etils of ny issues tht oul ffet the Fitness n Propriety of the iniviul tht rose when leving n employer liste in Setion 4 or if ny question hs een nswere yes in Setion 5) Question Informtion Note: If there is insuffiient spe, plese ontinue on seprte sheet of pper n lerly ientify the setion n question to whih the itionl informtion reltes Firms must lso provie the following supporting ouments require with this form (plese tik) It is for firms to sses whih supporting ouments they shoul sumit ut, in the mjority of ses, it is expete tht firms will sumit ll of the liste supporting ouments. Sttement of responsiilities Cnite s Curriulum Vite (C.V) Role(s) esription A opy of the firm s mngement responsiilities mp (SYSC 25 n Allotion of Responsiilities in the PRA Ruleook). 4 This requirement oes not pply to ll firms. A summry of ny hnover mteril (s referre to in SYSC 25.9 n SUP 10C.10 n senior mngement funtions in the PRA Ruleook). 5 This requirement oes not pply to ll firms. 4 The relevnt setion of the PRA Ruleook shoul e referre to epening on whih firm is pplying 5 The relevnt setion of the PRA Ruleook shoul e referre to epening on whih firm is pplying. Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 23

24 A esription or opy of the nite s Skills Gp Anlysis. A esription or opy of the nite s Inution progrmme A esription or opy of the nite's Lerning n Development pln (inluing the nme of the iniviul responsile for monitoring the nite's progress ginst the evelopment points n the time frme for ompletion) A esription or oumenttion setting out how the ompeteny ws ssesse (emonstrting ompetene n suitility mppe to the speifi role n responsiilities of the role). Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 24

25 Delrtions n signtures Setion 7 Delrtion of Cnite It is riminl offene, knowingly or reklessly, to give the FCA n/or PRA informtion tht is mterilly flse, misleing or eeptive (see setions 398 n 400 of the Finnil Servies n Mrkets At 2000 FSMA ). Even if you elieve or know tht informtion hs een provie to the FCA n/or PRA efore (whether s prt of nother pplition or otherwise) or is in the puli omin, you must nonetheless islose it lerly n fully in this form n s prt of this pplition you shoul not ssume tht the FCA n/or PRA will itself ientify suh informtion uring the ssessment of this pplition. There will e ely in proessing the pplition if informtion is inurte or inomplete, n it my ll into question the suitility of the nite n/or le to the FCA n/or PRA exerising their powers (inluing ut not limite to tking isiplinry/ Enforement tion). You must notify the FCA n/or PRA immeitely if there is hnge to the informtion in this form n/or if inurte informtion hs een provie (insofr s the FCA n/or PRA re resonly likely to onsier the informtion mteril). The nite onfirms tht the informtion provie in this pplition is urte n omplete to the est of their knowlege n tht they hve re the notes to this form. The nite will notify the FCA n/or PRA immeitely if there is mteril hnge to the informtion provie. The nite onfirms tht the tthe sttement of responsiilities urtely reflets the spets of the ffirs of the firm whih it is intene tht the nite will e responsile for mnging. The nite onfirms tht they hve epte ll the responsiilities set out in this sttement of responsiilities. The nite grees tht the FCA n/or PRA my use the ress speifie for the nite in this form s the proper ress for servie in the Unite Kingom (s efine in the Finnil Servies n Mrkets At 2000 (Servie of Noties) Regultions (SI 2001/1420)) to serve ny noties on the nite. For the purposes of omplying with t protetion legisltion, plese re our privy noties: FCA s privy notie Bnk of Engln s privy notie These noties will tell you wht to expet when the FCA n/or the Bnk of Engln ollets personl informtion, inluing how n why we use your personl informtion n who to ontt if you hve ny queries or wish to exerise your rights. The nite onfirms tht they unerstn the regultory responsiilities of the propose role s set out in the rules of onut in the FCA s COCON or APER n/or the PRA Ruleook: Conut Rules, Insurne Conut Stnrs, Non- Solveny II Firms Conut Stnrs, n Lrge Non-Solveny II Firms Conut Stnrs. The nite is wre tht, while vie my e sought from thir prty (e.g. legl vie), responsiility for the ury of informtion, s well s the islosure of relevnt informtion, on the form is ultimtely the responsiility of those who sign the pplition. In ition to other regultory responsiilities, firms n nites/pprove persons hve responsiility to islose to the FCA n/or PRA mtters of whih it woul resonly expet to e notifie. Filure to notify the FCA n/or PRA of suh informtion my le to the FCA n/or PRA tking isiplinry or other tion ginst the Applint n/or the nite. Tik here to onfirm you hve re n unerstoo this elrtion: 7.01 Nme of nite 7.02 Signture Dte Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 25

26 Delrtion of Firm It is riminl offene, knowingly or reklessly, to give the FCA n/or PRA informtion tht is mterilly flse, misleing or eeptive (see setions 398 n 400 of the Finnil Servies n Mrkets At). Even if you elieve or know tht informtion hs een provie to the FCA n/or PRA efore (whether s prt of nother pplition or otherwise) or is in the puli omin, you must nonetheless islose it lerly n fully in this form n s prt of this pplition you shoul not ssume tht the FCA n/or PRA will itself ientify suh informtion uring the ssessment of this pplition. If there is ny out out the relevne of informtion, it shoul e inlue There will e ely in proessing the pplition if informtion is inurte or inomplete, n it my ll into question the suitility of the nite n/or le to the FCA n/or PRA exerising their powers uner FSMA (inluing ut not limite to tking isiplinry/ Enforement tion). You must notify the FCA n/or PRA immeitely if there is hnge to the informtion in this form n/or if inurte informtion hs een provie (insofr s the FCA n/or PRA re resonly likely to onsier the informtion mteril). In ition to other regultory responsiilities, firms n nites/ pprove persons hve responsiility to islose to the FCA n/or PRA, mtters of whih it woul resonly expet to e notifie. Filure to notify the FCA n/or PRA of suh informtion my le to the FCA n/or PRA tking isiplinry or other tion ginst the Applint n/or the nite. The Applint onfirms tht the informtion provie in this pplition is urte n omplete to the est of its knowlege n tht it hs re the notes to this form. The Applint will notify the FCA n/or PRA immeitely if there is mteril hnge to the informtion provie. The Applint uthorises the FCA n/or PRA to mke suh enquiries n seek suh further informtion s it thinks pproprite to ientify n verify informtion tht it onsiers relevnt to the ssessment of this pplition. Where pplile, the Applint onfirms tht it hs requeste the fullest informtion tht it is lwfully le to otin out the nite uner Prt V of the Polie At 1997 n ny relte suorinte legisltion of the UK or ny prt of the UK, n (where ville) hs given ue onsiertion to tht informtion in etermining tht nite to e fit n proper. In mking this pplition the Applint elieves on the sis of ue n iligent enquiry n, where pplile, y referene to the riteri in FIT in the FCA Hnook n/or the Fitness n Propriety prt of the PRA Ruleook tht the nite is fit n proper person to perform the ontrolle funtion(s) liste in Setion 3. The Applint lso elieves, on the sis of ue n iligent enquiry, tht the nite is ompetent to fulfil the uties require in the performne of suh funtion(s). Note: For EEA firms, this woul only pply to those firms unertking ny non MiFID usiness. The Applint onfirms tht it hs omplie with its oligtions uner equlity n iversity legisltion when seleting the nite to perform the funtion(s) pplie for. The Applint onfirms tht it hs me the nite wre of their regultory responsiilities s set out in the rules of onut in the FCA s COCON or APER n/or the PRA Ruleook: Conut Rules, Insurne Conut Stnrs, Non- Solveny II Firms Conut Stnrs n Lrge Non-Solveny II Firms Conut Stnrs. The Applint onfirms tht the sttement of responsiilities sumitte with this form urtely reflets the spets of the ffirs of the firm whih it is intene tht the nite will e responsile for mnging. The Applint is wre tht, while vie my e sought from thir prty (e.g. legl vie), responsiility for the ury of informtion, s well s the islosure of relevnt informtion, on the form is ultimtely the responsiility of those who sign the pplition. For the purposes of omplying with t protetion legisltion, plese re our privy noties: FCA s privy notie Bnk of Engln s privy notie These noties will tell you wht to expet when the FCA n/or the Bnk of Engln ollets personl informtion, inluing how n why we use your personl informtion n who to ontt if you hve ny queries or wish to exerise your rights. In signing this form on ehlf of the Applint firm: I onfirm tht the informtion in this form is urte n omplete to the est of my knowlege n elief n tht I hve re the notes to this form. I onfirm tht I hve uthority to mke this pplition n provie the elrtions given y the Applint, n sign this form, on ehlf of the firm ientifie in Setion 2.01 n/or eh firm ientifie in Setion I lso onfirm tht opy of this form, s sumitte to the FCA n/or PRA, will e sent to eh of those firms t the sme time s sumitting the form to the FCA n/or PRA. Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 26

27 7.03 Nme of the firm sumitting the pplition 7.04 Nme of person signing on ehlf of the Applint firm 7.05 Jo title 7.06 Signture Dte Long Form A Dul-regulte firms (inluing EEA n thir ountry firms) Pge 27