Form ASP1 Ancillary Service Provider Application for registration

(For DFSA use only) Form ASP1 Ancillary Service Provider Application for registration Name of applicant Firms are requested to contact the authorisation department of the DFSA (+9714 362 1500) before considering completing an application. 1 of 13 ASP1/VER5/10-08

Purpose of this form This form must be submitted by a Person applying for registration to carry on one or more Ancillary Services in or from the DIFC. An application must be submitted in relation to one or more of the Ancillary Services contained in section 2 question 2.1. 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 nominated contact identified in section 1. Contents This form consists of seven sections: 1. Applicant details 2. Ancillary Services 3. Anti Money Laundering 4. Fit & proper questionnaire for AMLO 5. Payment of Fees 6. Declaration 7. 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 Glossary module (GLO) of the DFSA s Rulebook. All 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 and the Anti Money Laundering Officer (if different). Please ensure any supporting documentation is clearly labelled and securely attached. 2 of 13 ASP1/VER5/10-08

1. APPLICANT DETAILS 1.1 Full or proposed name of applicant to be registered 1.2 Applicant s registered office in DIFC (Please indicate if current or proposed) 1.3 Applicant s head office if different from 1.2 1.4 Main telephone number of address in 1.3 (incl. country and area codes) 1.5 Main fax number of address in 1.3 (incl. country and area codes) 1.6 Website address (if applicable) 1.7 Applicant s contact person for this application Position/title Correspondence address (if different from 1.2 above) Telephone number: Fax number E-mail address 1.8 Please provide details of any adviser engaged by the applicant to assist with the preparation and ongoing support of this application. Name of the adviser engaged by the applicant Relevant contact person within the adviser Contact address 3 of 13 ASP1/VER5/10-08

Telephone/Fax number: E-mail address 1.9 Legal nature of applicant (e.g. Company, LLP, Partnership, etc) 1.10 Date and place of incorporation /formation of the applicant Note: Please attach a copy of the applicant s certificate of incorporation/company registration (if applicable). If in the process of being formed, please state in formation 1.11 Please advise the applicant s expected end of financial year date 1.12 Is the applicant currently, or has the applicant ever been, the subject of any government or regulatory investigation, received a fine or been involved or currently involved in disciplinary proceedings? If YES, please provide details below. Yes No 4 of 13 ASP1/VER5/10-08

2. ANCILLARY SERVICES 2.1 Ancillary Services (as defined in ASP) 2.1.1 Providing Legal Services 2.1.2 Providing Accountancy Services 2.2 If applying for the activity 2.1.1 Providing Legal Services, Have you been granted a Ruler s Court or UAE Ministry of Justice Licence? Yes No If YES, please attach a copy along with an English translation. If NO, please note that applicants for legal services must be appropriately licensed by either the Dubai Ruler s Court or the UAE Ministry of Justice, as applicable, before submitting this application. 2.3 Please provide a description of the customers to whom the Ancillary Services are to be provided. Do you have a letter of intent from one of your proposed clients who is licensed by the DFSA as an Authorised Firm or AMI? Yes No If YES please attach a copy. If NO please obtain the letter of intent before submitting this application. ASP status will only be granted to providers of accountancy or legal services to DFSA regulated entities. Prior to registration as an ASP an accounting or legal firm may market services to regulated firms, but may not commence the provision of such services. ASPs shall not accept a mandate from a regulated entity to provide professional services within the DIFC (nor accept appointment to a tender panel for the provision of such services) until registered as an ASP. Application for such registration must include written evidence from a regulated entity of its intention to retain professional services of the applicant (or appoint the applicant to a tender panel for the provision of such services). 5 of 13 ASP1/VER5/10-08

3. ANTI MONEY LAUNDERING 3.1 Please attach the applicant's anti Money Laundering policies, procedures, systems and controls (which must be specific to its DIFC activities and comply with the ASP AML Rules of the DFSA including an overview of the applicant s anti Money Laundering function including staffing levels, responsibilities and reporting lines). The applicant s procedures should include, amongst other things, arrangements to: a) Ensure compliance with the UAE Law No.4 and any other relevant UAE federal laws; b) Monitor for, detect and report suspicious customers and Transactions; Note: Applicants should ensure the procedures comply with the requirement for Suspicious Transaction Reports (STRs) to be made in the required format to the Anti Money Laundering Suspicious Cases Unit (AMLSCU), and a copy provided to the DFSA. Details of the required format of the report and details for submission can be found on the DFSA website; c) Establish and verify the identity of the customer and any other person on whose behalf the customer is acting, including that of the beneficial owner; unless exception applies (6.5) d) Provide an audit trail of AMLO; e) Determine the duties and obligations of its MLRO; f) Review the effectiveness of its anti Money Laundering policies, procedures, systems and controls at least annually; g) Respond to any request for information made by competent U.A.E. authorities or the DFSA; h) Maintain AML relevant documents and records; i) Ensure that it obtains and makes use of findings in relation to names of persons, groups, organisations or entities, or any other body where suspicion of Money laundering or terrorist financing exists; Be mindful of Government; regulatory and international findings j) Assess its risks in relation to Money laundering and to perform enhanced due diligence investigations for higher risk products, services and customers; k) Determine whether a customer is a Politically Exposed Person (PEP); l) Establish and maintain an anti Money Laundering training programme and awareness arrangements; and m) Ensure compliance with any other obligation in the DFSA's ASP module. 3.2 Anti Money Laundering Officer (AMLO) 3.2.1 Family name/other names 3.2.2 Date of birth (DD/MM/YYYY) 3.2.3 Place of birth 3.2.4 Passport(s) number(s) 3.2.5 Please state the country(ies) and place(s) of issue of the applicant s passport(s) Please attach a copy of all passports held by the applicant, including copies of any current visas. 6 of 13 ASP1/VER5/10-08

3.2.6 Job title/level within the firm Please attach a detailed job description clearly outlining the AMLO s role and responsibilities within the firm and attach details of the AMLO s employment record for the previous 10 years highlighting any experience relevant to the role of AMLO. 3.2.7 Please confirm the AMLO will ordinarily reside in the UAE 3.2.8 Residential address 3.2.9 Dates resident at above ad dress (from/to) 3.2.10 Previous address if less than 3 years at above address Yes No 3.2.11 Contact details Telephone Fax E-mail 3.2.12 What steps will be taken by the applicant to ensure that the AMLO will be fully aware of his duties and be able to carry out his function effectively? Please provide details. 3.2.13 Do another jurisdiction's laws or Regulations prevent or inhibit the applicant from complying with the U.A.E. Law No.4 or the DFSA Rules? Yes No If Yes, please give full details Note: Should such an event arise in the future ASPs are obliged to notify DFSA in writing promptly 7 of 13 ASP1/VER5/10-08

4. FIT & PROPER QUESTIONNAIRE FOR AMLO 4.1 Please complete the following questionnaire in relation to the applicant AMLO Answers must be provided to every question. Has the applicant AMLO: Yes No (i) (ii) (iii) (iv) (v) been convicted or found guilty by any Court of competent jurisdiction in respect of any offence, other than a minor road traffic offence? ever been the subject of disciplinary procedures by a government body or agency or any self Regulatory organisation or other professional body? contravened any provision of Financial Services legislation or of Rules, Regulations, statements or principle or codes of practice made under or by a Financial Services Regulator or other supervisory body? been refused or restricted the right to carry on a trade, business or profession requiring a licence, registration or other authority? been dismissed or requested to resign from any office of employment? (vi) (vii) (viii) (ix) (x) been concerned with the management of a Body Corporate which has been or is currently the subject of an investigation into a allegation of misconduct or malpractice? received an adverse finding in a civil action by any Court of competent jurisdiction of fraud, misfeasance, or other misconduct, whether in connection with the formation or management of a corporation or otherwise? received an adverse finding in an agreed settlement in a civil action by any Court or tribunal of competent jurisdiction resulting in an award against an individual in excess of $10,000 or awards that total more than $10,000? been the subject of an order of disqualification as a Director or otherwise to act in the management or conduct of the affairs of a corporation by a Court of competent jurisdiction or Regulator? been a Director, or Partner or concerned in the management of a company or Partnership which has gone into insolvent liquidation whilst the individual was connected with that company, Partnership or within one year of such a connection? 8 of 13 ASP1/VER5/10-08

(xi) (xii) been the subject of complaint in connection with a Financial Service or Ancillary Service which relates to his integrity, competence or financial soundness? been censured, disciplined, publicly criticised by or the subject of a Court order at the instigation of a Financial Services Regulator or any officially appointed inquiry? If you have answered Yes to any questions, please provide appropriate details of the matter below. 9 of 13 ASP1/VER5/10-08

5. PAYMENT OF FEES All applications must be accompanied by payment of the relevant application fee. Details of the application fees are contained in the GEN module of the DFSA Rulebook until 30 November 2007, and in the FER module from 1 December 2007 when revised fees will come into effect. To review the revised fees in advance of 1 December 2007, please refer to Appendix 1 of the Fees Rules Instrument (No. 52) 2007 ( RM52/2007 ), which can be found under the Rulebook Modules section of the DFSA s website, www.dfsa.ae. Please make the payment by Bank transfer free of charges to the account listed below. Cheques or Bank drafts cannot be accepted. Applications will not be processed until the full relevant fee is received by the DFSA. Account name Dubai Financial Services Authority Account number 020 683751-100 Bank details Swift code Reference to be quoted HSBC Bank Middle East PO Box 66 Dubai, UAE BBMEAEAD Application fee [applicant name] 10 of 13 ASP1/VER5/10-08

6. DECLARATION 6.1 Declaration by the firm 6.1.1 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. 6.1.2 I declare my understanding that the DFSA may request more detailed information (including but not limited to, personal, educational, employment and financial information) should it be deemed necessary to adequately assess the fitness and propriety of the firm or any person connected to the firm. I consent to the DFSA contacting any previous employers, educational institutions, professional organisations or any other organisation, to verify any information contained in this form. 6.1.3 I declare that the firm and its Employees are fit and proper to perform the firm s Ancillary Services. 6.1.4 I declare my understanding that carrying on a Financial Service in or from the DIFC without an appropriate Licence is prohibited under Article 41 of the Regulatory Law 2004 and that registration as an Ancillary Service Provider does not authorise the firm to carry on any Financial Services in or from the DIFC. 6.1.5 I confirm that I have the authority to make this application, to declare as specified above and sign this form for, or on behalf of, the applicant. I also confirm that I have the authority to give the consent specified above. 6.1.6 For the purposes of the Data Protection Law 2004, the personal data provided in this form will be processed by the DFSA in accordance with Article 8 of the Data Protection Law 2004, in particular, in the exercise of its functions or powers under legislation administered by the DFSA or where necessary for the performance of a task carried out in the interests of the DIFC. 6.2 Consent by the applicant for disclosures to the Dubai International Finance Centre Authority (DIFCA) The provision of information by the DFSA under the following consent will assist the DIFCA with exercising its functions and powers, including in relation to establishing your firm s presence in the centre. It is not mandatory to provide consent. Should you not wish to provide consent, we ask that you keep the DIFCA informed of the progress of your application. I consent to disclosure of the following information by the DFSA to DIFCA, in each case on or after the date stipulated: 1. The fact of the filing of this application, together with the name of the applicant, on or after the date of filing with the DFSA: and 2. A decision by the DFSA to approve this application, and whether or not approval is or will be subject to pre conditions, on or after the date of that decision. 11 of 13 ASP1/VER5/10-08

Name of a Director/Partner / / Signature of a Director/Partner Date Name of the AMLO if different from above / / Signature of the AMLO Date 12 of 13 ASP1/VER5/10-08

7. ATTACHMENTS Section Document Attached? 1.10 Certificate of Incorporation/Company Registration 2.2 Approval from Ruler s Court of Dubai or UAE Ministry of Justice (as applicable) copy of Licence 2.3 Letter of Intent from AF or AMI 3.1 Anti Money Laundering procedures 3.2.5 Copy(ies) of passport(s) 3.2.6 AMLO job description 3.2.6 AMLO employment details for the last 10 years 4 Fit & Proper questionnaire AMLO 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 13 of 13 ASP1/VER5/10-08