! Regulated company (licensed by an Australian Commonwealth, State or Territory statutory regulator)
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- Terence Newman
- 5 years ago
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1 GUIDE TO COMPLETING THIS FORM o Complete ONE of the following:! Section 1 (all parts) for Australian Companies! Section 2 (all parts) for Foreign Companies o Only send the completed sections of this form with the application form. o Contact your licensee if you have any queries SECTION 1A: AUSTRALIAN COMPANY DETAILS (to be completed if company is an Australian Company) 1.1 General Information Full name as registered by ASIC ACN Registered office address (PO Box is NOT acceptable) Principal place of business (if any) (PO Box is NOT acceptable) 1.2 Regulatory/ Listing Details (select " the following categories which apply to the company and provide the information requested)! Regulated company (licensed by an Australian Commonwealth, State or Territory statutory regulator) Regulator name Licence details! Australian listed company! Majority-owned subsidiary of an Australian listed company Australian listed company name 1.3 Company Type (select " only ONE of the following categories)! Public Go to Section 1B below.! Proprietary Go to Section 1.4 below. 1.4 Directors (only needs to be completed for proprietary companies) This section does NOT need to be completed for public and listed companies. How many directors are there? provide full name of each director If there are more directors, provide details on a separate sheet If the company is a regulated company (as selected in Section 1.2 above) go to Section 1B below. Otherwise, for all other proprietary companies continue to Section 1.5 below. V
2 1.5 Shareholders (only needs to be completed for proprietary companies that are not regulated companies as selected in Section 1.2) Provide details of ALL individuals who are beneficial owners through one or more shareholdings of more than 25% of the company s issued capital Shareholder 1 Shareholder 2 Shareholder 3
3 SECTION 1B: AUSTRALIAN COMPANY VERIFICATION PROCEDURE Standard verification procedure o The full name of the company as registered by ASIC o Whether the company is registered as a proprietary or a public company o The ACN issued to the company. Verification options (select one of the following options used to verify the Company)! If the ASIC database is not reasonably available, an original or certified copy of the certification of registration issued by ASIC. Alternative verification procedure For a company which is an Australian listed company, a majority owned subsidiary of an Australian listed company or is a regulated company (ie licensed by an Australian Commonwealth, State or Territory statutory regulator). o That the company is an Australian listed company (if applicable) o That the company is a majority owned subsidiary of an Australian listed company (if applicable) o That the company is a regulated company (if applicable). Verification options (select one or more of the following options used to verify the Company)! Perform a search of the relevant market/exchange.! Perform a search of the licence or other records of the relevant Commonwealth, State or Territory statutory regulator.! A public document issued by the relevant company. SECTION 1C: RECORD OF VERIFICATION PROCEDURE IMPORTANT:! Attach a legible copy of the ID documentation used to verify the Company.! Alternatively, if agreed between your licensee and the product issuer, complete the ID Document Details below, and DO NOT attach copies of the ID Documents. ID DOCUMENT DETAILS Document 1 Document 2 Verified From! Performed search! Original! Certified copy! Performed search! Original! Certified copy Document Issuer / Website Public Document Type Issue date / Search date SECTION 1D: FINANCIAL PLANNER DETAILS identification and verification conducted by: Date Verified (dd/mm/yyyy) Financial Planner s Name Phone No. AFS Licensee Name AFSL No. If the company is an Australian company, the form is now COMPLETE.
4 SECTION 2A: FOREIGN COMPANY DETAILS (to be completed if the company is a Foreign Company) 2.1 General Information Full name of foreign company Country of formation / incorporation / registration! Select " if registered by a foreign body and provide name of body 2.2 Is the foreign company registered with ASIC? (select " ONE of the following)! Yes Provide ARBN Provide EITHER! principal place of business address in Australia OR! local agent name and address details (Tick one box) Address (PO Box is NOT acceptable) Name of local agent in Australia! No Provide company identification number (if any) issued by the foreign registration body Principal place of business in the company s country of formation or incorporation (PO Box is NOT acceptable) 2.3 Registered Address of Company Provide the registered address as registered with ASIC. If the company is NOT registered with ASIC, provide the registered address in the country of formation, incorporation or registration (if any). 2.4 Regulatory/ Listing Details (select " each of the following categories that apply to the company & provide the information requested)! Regulated company (licensed by an Australian Commonwealth, State or Territory statutory regulator) Regulator name Licence details! Listed as defined in the IFSA/FPA Guidelines! Majority-owned subsidiary of an Australian listed company Australian listed company name 2.5 Company Type (select " only ONE of the following categories and provide any information requested)! Public Go to Section 2.6 below.! Private/Proprietary Go to Section 2.6 below.! Other Go to Section 2.6 below.
5 2.6 Directors (complete for all companies other than public or listed companies) How many directors are there? provide full name of each director below If there are more directors, provide details on a separate sheet. If the company is a regulated company (as selected in Section 2.4 above) go to Section 2B below. Otherwise, for all other private, proprietary or other companies continue to Section 2.7 below. 2.7 Shareholders (complete for all companies other than public, listed or regulated companies) Provide details of ALL individuals who are beneficial owners through one or more shareholdings of more than 25% of the company s issued capital Shareholder 1 Shareholder 2 Shareholder 3
6 SECTION 2B: FOREIGN COMPANY VERIFICATION PROCEDURE Standard verification procedure for Foreign Companies registered with ASIC o The full name of the company as registered by ASIC o The ARBN issued to the company o Whether it is registered by a foreign registration body and if so! whether it is registered as a private company or a public company. Verification options (select one of the following options used to verify the Company)! Perform a search of the relevant foreign registration body.! If the ASIC or foreign registration body database is not reasonably available, an original or certified copy of the certification of registration issued by ASIC or by the relevant foreign registration body. Standard verification procedure for Foreign Companies NOT registered with ASIC o The full name of the company o Whether it is registered by a foreign registration body and if so! whether it is registered as a private or a public company! the identification number issued to the company Verification options (select one of the following options used to verify the Company)! Perform a search of the relevant foreign registration body.!! If the foreign registration body database is not reasonably available, an original or certified copy of the certification of registration issued by the relevant foreign registration body. Where the above means are unavailable, a disclosure certificate from the company given by an individual acting as agent of the company (where the agent has been verified). See your licensee for other disclosure certificate requirements. Alternative verification procedure For a company which is a listed company, a majority owned subsidiary of an Australian listed company or is a regulated company (ie licensed by an Australian Commonwealth, State or Territory statutory regulator). o That the company is a listed company (if applicable) o That the company is a majority owned subsidiary of an Australian listed company (if applicable) o That the company is a regulated company (if applicable). Verification options (select one of the following options used to verify the Company)! Perform a search of the relevant financial market.! Perform a search of the licence or other records of the relevant Commonwealth, State or Territory statutory regulator.! A public document issued by the relevant company. Documents that are written in a language that is not English must be accompanied by an English translation prepared by an accredited translator. SECTION 2C: RECORD OF VERIFICATION PROCEDURE IMPORTANT:! Attach a legible copy of the ID documentation used to verify the Company (and any required translation).! Alternatively, if agreed between your licensee and the product issuer, complete the ID Document Details below, and DO NOT attach copies of the ID Documents. ID DOCUMENT DETAILS Document 1 Document 2 Verified From! Performed search! Original! Certified copy! Performed search! Original! Certified copy Document Issuer / Website Public Document Type Issue date / Search date Accredited English Translation! N/A! Sighted! N/A! Sighted SECTION 2D: FINANCIAL PLANNER DETAILS identification and verification conducted by: Date Verified (dd/mm/yyyy) Financial Planner s Name AFS Licensee Name Phone No. AFSL No.
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