Appendix 5 - Forms and Templates (2024)

FAA Form

Foreign Account Application (FAA Form) to the Banking Supervision Department **

**Email the duly filled in FAA Form & Relationship Details Spreadsheet (Refer to Notice 171/2017 dated 12^th June 2017 issued by the Central Bank) to info.ehs@cbuae.gov.ae along with a letter signed by the Authorised Signatory of the Exchange House seeking the approval for the above relationships and the draft of the agreements.

*** Provide the details in a separate FAA Form in case the number of relationships exceeds 5.

CRV Form

Certificate of Remittance Value (CRV Form) to the Banking Supervision Department **
(To be submitted within two (2) months from the end of every financial year)

Date:

To

The Chief Manager,
Licensing Division, Banking Supervision Department,
Central Bank of the UAE, Abu Dhabi, UAE.

Dear Sir

Sub: Certificate of Remittance Value

We hereby certify the following information after verifying the books of accounts of ……………………………………………..… (Name of the Exchange House) for the financial year ended on 31^st December ………………..

Yours Faithfully,

**Email the duly filled in CRV Form to info.ehs@cbuae.gov.ae and then submit the original to the BSD.

*** Remittance Turnover means the total value of inward and outward remittances. Domestic remittances, where the origin and destination of remittances are within the UAE, are excluded.

FIR Form

Fraud Incident Reporting (FIR Form) to the Banking Supervision Department**

** Email the duly filled in FIR Form to info.ehs@cbuae.gov.ae and then submit the original to the BSD.

*** Provide the details in a separate page in case more than one individual involved in the incident.

CIR Form

Counterfeit Incident Reporting (CIR Form) to the Banking Supervision Department**

** Email the duly filled in CIR Form to info.ehs@cbuae.gov.ae and then submit the original to the BSD.

*** Provide the details in a separate page in case more than one individual involved in the incident.

LPA Form (Page – 1/15)

EXCHANGE BUSINESS

LICENSED PERSON’S
APPLICATION FORM
(LPA FORM)

Please return completed form, together with supporting documentation to Licensing Division, Banking Supervision Department, Central Bank of the U.A.E.

LPA Form (Page – 2/15)

Table of Contents

LPA Form (Page – 3/15)

Section 1: GUIDELINES

1. 1.Any person may submit to the Central Bank an application for a new license, change license category or change in capital or shareholding structure of license. However, any material changes or proposed changes to the information provided in support of an application must be immediately reported to the Central Bank.
2. 2.An applicant may appoint a representative to prepare and submit the application. However, the applicant retains full responsibility for the accuracy and completeness of the application. The Central Bank also expects to be able to liaise directly with the applicant during the assessment process, when seeking clarification of any issues.
3. 3.All documentation provided to the Central Bank must be in either Arabic or English. Any documentation in a language other than Arabic or English must be accompanied by Arabic or English translation. Moreover, all figures submitted must be in either AED or USD.
4. 4.Complete all sections as fully as possible, attaching supporting documents and continuation sheets where required.
5. 5.The Central Bank may require the applicant to amend aspects of their services/activities in order to comply with the licensing requirements.
6. 6.The applicant may withdraw its application at any time during the process by notifying the Central Bank.
7. 7.Failure to provide all required information may result in significant delays in processing the application. The Central Bank does not accept responsibility for any loss caused to the applicant by any such delay.
8. 8.If any question is not applicable in a particular circ*mstance, please clearly indicate by marking ‘N/A’, with an explanation as to why it does not apply.
9. 9.Applicants are reminded that no person may undertake an Exchange Business within or from the United Arab Emirates unless licensed by the Central Bank.
10. 10.Please return completed form, together with supporting documentation to:

Licensing Division - Banking Supervision Department
Central Bank of the U.A.E.

LPA Form (Page – 4/15)

Section 2: LICENSING PROCESS

1. 1.All potential new applicants are encouraged to contact the Central Bank at an early stage to discuss their plans and requirements. The Licensing Division at the Central Bank would expect to hold at least one pre-application meeting with the applicant, prior to receiving an application.
2. 2.Applicants must submit a formal application letter signed by an authorized signatory, including the request and reasons for applying.
3. 3.Applicants seeking new license must submit the following duly completed Forms, along with the related supporting documents:
   1. a)Licensed Person’s Application Form (LPA FORM)
   2. b)Authorised Person’s Appointment Form (APA FORM)
4. 4.Applicants seeking new license must submit all required documents as listed in ‘Section 7: REQUIRED DOCUMENTS’ of this Form.
5. 5.The Central Bank shall notify the applicant of the outcome of the application, which the Central Bank considers to be complete. The Central Bank will review the applications and accordingly advise the applicant in writing when it has:
   1. a)Approve the applicant’s request without conditions;
   2. b)Approve the applicant’s request subject to conditions specified by the Central Bank; or
   3. c)Reject the applicant’s request.
6. 6.Queries may be addressed to:

Licensing Division
Banking Supervision Department
Central Bank of the U.A.E.

LPA Form (Page – 5/15)

Section 3: APPLICANT’S DETAILS

Please submit all information requested below. You can use a continuation sheet if necessary. If the question is not applicable, please clearly indicate by marking ‘N/A’.

1. 1.Name of the applicant (Please provide the current and proposed, in case of change in the applicant’s name)
2. 2.Legal form (Please provide the current and proposed, in case of change in the legal form)
3. 3.Authorised and paid-up capital (Please provide the current and proposed, in case of change in the authorised and paid-up capital)
4. 4.Origin of the capital source(s), with the related bank documents as proof
5. 5.License category (Please provide the current and proposed, in case of change in the legal form)
6. 6.Reasons for applying at the Central Bank
7. 7.The external auditor (existing or to be appointed - specify which)

LPA Form (Page – 6/15)

Section 3: APPLICANT’S DETAILS (Continue)

1. 8.The organization structure with the reporting lines to be included. Please describe, and provide further details in the business plan. (For applications for new license or in case of change in the organization structure of a Licensed Person).
2. 9.Outline the framework of the company’s risk management and monitoring system with respect to the major potential risks. Please provide further details in the business plan. (For applications for new license)
3. 10.Supply details of any expansion plans (branches or subsidiaries inside or outside the UAE), and anticipated manpower/staffing requirements in the next three (3) years, reflecting the Emiratisation requirements (For applications for new license)
4. 11.Other ancillary activities. Please describe, and provide further details in the business plan. (For applications for new license)
5. 12.Details of any entity licensed or authorized within the group by a regulatory/supervisory authority (For applications for new license or change in capital or shareholding structure)

LPA Form (Page – 7/15)

Section 3: APPLICANT’S DETAILS (Continue)

1. 13.Has the applicant or member(s) of its group been the subject of any litigation or convicted in a Court of Law (or known circ*mstances which might give rise to litigation) over the past five (5) years, or is any litigation currently outstanding? If yes, please provide details
2. 14.Are there any restrictions imposed on the operations of the applicant or member(s) of its group by any regulatory authorities? If yes, please provide details
3. 15.Has the applicant had any of its previous applications in other countries rejected? If yes, please provide details (name of the Regulator, date of rejecting the application, reasons for the rejection)

LPA Form (Page – 8/15)

Section 4: SHAREHOLDERS/ OWNERS/ PARTNERS

1. 1.Please list all particulars required below (including previous names used) of all proposed shareholders, owners or partners. If space is insufficient, please provide on separate sheet of paper.

LPA Form (Page – 9/15)

Section 4: SHAREHOLDERS/ OWNERS/ PARTNERS (Continue)

1. 2.Please list all particulars required below (including previous names used) of all existing shareholders, owners or partners (if applicable). If space is insufficient, please provide on separate sheet of paper.

LPA Form (Page – 10/15)

Section 5: BOARD OF DIRECTORS

1. 1.Please complete the table below for all proposed members of the Board of Directors (if applicable). For “Other Responsibilities”, please list all positions held as board of director or senior manager in any other institutions or company.

1. 2.Please complete the table below for all existing members of the Board of Directors (if applicable). For “Other Responsibilities”, please list all positions held as board of director or senior manager in any other institutions or company.

LPA Form (Page – 11/15)

Section 6: AUTHORIZED PERSONS

1. 1.Please list all particulars required below (including previous names used) of all current and/or proposed Authorized Persons. Also, include completed Authorized Person Appointment Form (APA Form) along with the supporting documents for each proposed name provided.

1. 2.Please list all current and/or proposed Functions Heads below (including previous names used). If space is insufficient, please provide on separate sheet of paper.

LPA Form (Page – 12/15)

Section 7: REQUIRED DOCUMENTS

Please select the documents submitted with this form. If the required document is not applicable, please clearly indicate by marking ‘N/A’.

• ⬜A formal application letter signed by authorized signatory, including the request and reasons for applying.
• ⬜A certified copy of the Board resolution of the applicant, confirming its decision to seek a license/ change license category (if applicable).
• ⬜Copy of the commercial registration, where the applicant is an existing company.
• ⬜APA Forms for person wishing to undertake an authorized function.
• ⬜Business plan including short history of the applicant and its shareholders, the reasons for applying and market objectives, a description of the group and organizational structure, a brief summary of its key business lines, its mind and management, financial projections and all related assumptions covering at least the first three (3) years of operations, an assessment of potential risks and their mitigations, board and senior management, and any functions to be outsourced.
• ⬜Details of the applicant’s group structure.
• ⬜Copies of the audited financial statements of the applicant’s major shareholders (for corporates only) for the three (3) years preceding the application.
• ⬜A copy of the applicant’s memorandum and articles of association in draft form.
• ⬜A letter of non-objection to the applicant from the applicant’s lead supervisor (in the case of applicants that are part of a regulated group), and confirmation that it is in good regulatory standing and in compliance with applicable supervisory requirements.
• ⬜A copy of the certificate of license issued by the regulatory authority (In the case of applicants that are part of a regulated group).
• ⬜A capital deposit certificate from a licensed bank by Central Bank.
• ⬜The applicant’s location address and details of premises to be used to carry out the business.
• ⬜A copy of the required approvals from the Ministry of Economy and Department of Economic Development.

LPA Form (Page – 13/15)

Section 7: REQUIRED DOCUMENTS (Continue)

• ⬜Undertaking from the Shareholders to comply with the provisions of the Union Law No. (10) of 1980 concerning the Central Bank, the monetary system and organization of banking, and the decision of the Board of the Central Bank concerning the licensing and regulation of the exchange business in the country, as amended, and any other decisions or instructions or directives or circulars or correspondence issued by the Central Bank, as well as subjecting the institution / company records and documents to the Central Bank supervision and audit.
• ⬜An undertaking from the Shareholders to provide, in case the application is approved, a bank guarantee drawn in favor of the Central Bank issued by a bank licensed in the UAE.
• ⬜A certification / acknowledgment that the Shareholders are not bankrupt, issued and certified based on the applicable laws of the concerned authorities in the country (the courts).
• ⬜Bank statement of the Shareholders for a period of one (1) year from all banks that they are dealing with in the country.
• ⬜Written acknowledgment provided by the Shareholders confirming that they have never causes any financial losses bared by banks or other financial institutions operating in the UAE from any financial facility obtained from these banks or financial institutions.
• ⬜Written acknowledgment provided by the Shareholders that his/their contribution in the company is actual and not hypocritical for the benefit of any other party as an exchange for a commission.
• ⬜Bank reference of the Shareholders to be provided to the Central Bank from each bank they are dealing with during the past seven (7) years. The bank reference should include a paragraph about the cheques and whether the Shareholders have issued cheques that were bounced due to insufficient funds in their accounts during that specified period.
• ⬜Undertaking from the Shareholders that the company is committed to fulfill any obligations that may arise to third parties and any operations the company will undertake in the future.
• ⬜Undertaking from the Shareholders not to be committed to contracts that leads to financial obligations, prior to receiving the in-principal approval from the Central Bank to carry out Exchange Business.

LPA Form (Page – 14/15)

Section 7: REQUIRED DOCUMENTS (Continue)

• ⬜Undertaking from the Shareholders that if it was proven to the Central Bank that the license granted has been rented/ leased for a commission, the Central Bank has the right to cancel the license without referencing back to them.
• ⬜Undertaking from the Shareholders confirming that the company will:
  • •Not manage clients’ money in or outside the UAE, or open marginal accounts to their clients.
  • •Not rent this license, or any other license provided by the Central Bank, when granted to them in the future.
  • •Execute all exchange business activities based on receipts, advertise to customers clearly about currency rates, and keep copies of all receipts and correspondence regularly in accounting records.
  • •Not bail foreign financial facilities, nor act as a local agent to them.
  • •Not represent foreign financial facilities.
  • •Not sign contracts with foreign financial facilities for the management of the company.
• ⬜Undertaking from the Shareholders that they will be in contact with the Central Bank, and will inform the Central Bank of any changes in address or place of residence or change in their management positions. They should also record the minutes of their meetings and provide the Central Bank with a copy of them.
• ⬜Undertaking from the Shareholders that they are aware about all applicable Laws, Rules, Regulations, Notices and the Standards issued by the Central Bank regarding the exchange business and antimoney laundering on an ongoing basis, and the company will be keeping a copy of these laws and regulations in special files, where they will be held accountable for any failure in compliance with this requirement.

LPA Form (Page – 15/15)

Section 8: DECLARATION

We declare that the information submitted for this Form is complete and accurate to the best of our knowledge and that there are no other facts relevant to this Form that the Central Bank should be aware of.

We understand that providing any information to the Central Bank that is false or misleading in connection with this Form may result in the refusal of the application or, if discovered later, the subsequent cancellation of any approvals provided. We shall also inform the Central Bank of any material changes to the Form that may arise during the application.

We authorize the Central Bank to make such enquiries and seek further information it deems necessary in considering this application.

In case of application for new license, the above declaration must be signed by at least two major Shareholders. Should any shareholder is corporate, the declaration must be signed by two Directors of the Board, Owner, two major Partners, or two major Shareholders and bear the corporate seal.

In case of application for existing Licensed Persons, the above declaration must be signed by at least two Directors of the Board. In the absence of the Board of Directors, the above declaration must be signed by the Owner, two major Partners, or two major Shareholders.

APA Form (Page – 1/11)

EXCHANGE BUSINESS

AUTHORISED PERSON’S
APPOINTMENT FORM
(APA FORM)

Please return completed form together with supporting documentation to Supervision & Examination Division, Banking Supervision Department, Central Bank of the U.A.E.

APA Form (Page – 2/11)

Table of Contents

APA Form (Page – 3/11)

Section 1: GUIDELINES

1. 1.All Licensed Persons must submit a formal request letter and complete this Form for submission to the Central Bank prior to appointing any person who will be in charge of an Authorised Function (i.e. Manager in Charge, Compliance Officer or Alternate Compliance Officer). However, any material changes or proposed changes to the information provided in this Form must immediately be reported to the Central Bank.
2. 2.The Licensed Person retains full responsibility for the accuracy and completeness of the application. The Central Bank also expects to be able to liaise directly with the Licensed Person or Candidate during the assessment process, when seeking clarification of any issues.
3. 3.All documentation provided to the Central Bank must be in either Arabic or English. Any documentation in a language other than Arabic or English must be accompanied by a certified Arabic or English translation.
4. 4.All sections must be fully completed as possible, attaching supporting documents and continuation sheets where required.
5. 5.The Licensed Person may withdraw its application at any time during the process by notifying the Central Bank.
6. 6.Failure to provide all required information may result in significant delays in processing the application. The Central Bank does not accept responsibility for any loss, caused to the Licensed Person or to the candidate, as a result of such delay.
7. 7.If any question is not applicable in a particular circ*mstance, please clearly indicate by marking ‘N/A’, with an explanation as to why it does not apply.
8. 8.Licensed Persons are reminded that providing any information which is false or misleading may result in cancellation of the application or imposition of other disciplinary measures.
9. 9.Please return completed form, together with supporting documentation to:

Supervision & Examination Division
Banking Supervision Department
Central Bank of the U.A.E.

APA Form (Page – 4/11)

Section 2: AUTHORISATION PROCESS

1. 1.Licensed Persons must ensure that they meet the minimum requirements before submitting an application, including, where applicable, the minimum qualifications and competency requirements of the requested position.
2. 2.Licensed Persons must submit a formal application letter signed by an authorized signatory of the Licensed Person, highlighting the requested position along with this Form. The Licensed Person must submit any related information that may be important to the application, which was not covered in this Form. It must not be assumed that information is known to the Central Bank merely because it is in the public domain or has previously been disclosed to the Central Bank or another regulatory body. If there is any doubt about the relevance of information, it must be disclosed.
3. 3.Licensed Persons must submit all required documents as listed in ‘Section 7: REQUIRED DOCUMENTS’ of this Form.
4. 4.The Central Bank may require the Licensed Person to provide further information at any time after receiving this Form and before determining whether approval is to be granted or not.
5. 5.A meeting with the candidate may be required prior to finalizing the outcome of the application.
6. 6.The Central Bank shall notify the Licensed Person of the outcome of the application within sixty (60) days from the date of receiving the application, which the Central Bank considers complete. The Central Bank will review the applications and accordingly advise the Licensed Person in writing when it has:
   1. (a)Granted an approval without conditions;
   2. (b)Granted an approval subject to conditions specified by the Central Bank; or
   3. (c)Refused the application.
7. 7.Queries may be addressed to Banking Supervision Department, Central Bank of the U.A.E via email:

   info.ehs@cbuae.gov.ae

APA Form (Page – 5/11)

Section 3: CANDIDATE’S DETAILS

Please submit all information requested below. You may use a continuation sheet if necessary. If the question is not applicable, please clearly mark as ‘N/A’.

1. 1.Name of the candidate for the position of Authorized Person
   

   First Name:	Middle Name:
   Family Name:	Alias:
   Gender:

2. 2.Has the candidate had any previous name (s) by which he (she) is known? If yes, please specify
   
3. 3.Names of companies owned by the candidate or members of the candidate’s direct family where ownership is equal to or greater than 5%
   

   Name of Company	Country	Nature of Business	Ownership %	Ownership Amount

4. 4.Details of any company where the candidate currently serves as a director, when the directorship started and the countries in which the company is registered
   

   Date (from)	Name of Company/Nature of Business	Country	Position

APA Form (Page – 6/11)

Section 3: CANDIDATE’S DETAILS (Continue)

1. 5.Details of all academic and professional qualifications as well as the year and place where these were obtained (please enclose certified copies)

1. 6.Details of employment over the past ten (10) years, including the full name and the employer, the nature of the business, the position held and the relevant datesaddress of of service

APA Form (Page – 7/11)

Section 4: FUNCTION DETAILS

1. 1.Position for which the candidate is being nominated:
2. 2.Responsibilities of the proposed position:
3. 3.Draft copy of the candidate’s employment contract, stipulating all responsibilities and powers delegated to him/her, with a clause clarifying that any violation he/she commits would be criminal if it is proven that he has signed an incorrect or misleading document.
4. 4.Organization Chart (showing the candidate upward and downwards reporting lines).

APA Form (Page – 8/11)

Section 5: ELECTRONIC APPOINTMENT APPLICATION FORM

Please submit the Excel worksheet of the Electronic Appointment Application Form along with the related documents in Arabic only as per Notice No. 249/2016 dated 3^rd August 2016 to:

Email: obaid.romaithi@cbuae.gov.ae
Copy to: info.ehs@cbuae.gov.ae

Also, submit hard copies of the above-mentioned Excel worksheet along with the related documents to:

Supervision & Examination Division
Banking Supervision Department
Central Bank of the U.A.E.

Queries regarding the Electronic Appointment Application Form may be addressed to the Banking Supervision Department, Central Bank of the UAE:

Mr. Obaid Al- Romaithi
Telephone: 02-6915240
Email: obaid.romaithi@cbuae.gov.ae
Copy to: info.ehs@cbuae.gov.ae

Section 6: INTRODUCTORY STATEMENT FORM

Please return the completed Introductory Statement form in either Arabic or English to:

Supervision & Examination Division
Banking Supervision Department
Central Bank of the U.A.E.

APA Form (Page – 9/11)

Section 7: REQUIRED DOCUMENTS

Please select the documents submitted with this form. If the required document is not applicable, please clearly indicate by marking ‘N/A’.

• ⬜A formal application letter signed by authorized signatory.
• ⬜A bank reference from one or more banks for the past seven (7) years, confirming that the candidate has had no cheques returned during this period.
• ⬜Certified copies of academic and professional qualifications.
• ⬜Organization Chart showing the candidate upward and downwards reporting line.
• ⬜Soft copy of the Excel worksheet of the Electronic Appointment Application Form with the related documents to be sent to obaid.romaithi@cbuae.gov.ae under copy to info.ehs@cbuae.gov.ae.
• ⬜Hard copy of the Excel worksheet of the Electronic Appointment Application Form with the related documents to Supervision & Examination Division, the Central Bank.
• ⬜Completed Introductory Statement form with the related documents to Supervision & Examination Division, the Central Bank.
• ⬜An undertaking from the candidate confirming that he/she has never inflicted or caused losses for or on behalf of any institution operating in the UAE (Applicable for Manager in Charge only).
• ⬜An undertaking from the candidate confirming that he/she is fully aware of the Laws, Rules, Regulations, Notices and the Standards related to the Exchange Business, and that he/she would be fully prepared to attend a personal interview with senior officials at the Central Bank.
• ⬜An undertaking letter from the candidate confirming that all educational documents provided to the Central Bank are duly attested by the competent authorities. Applications will be rejected if educational documents are not attested.
• ⬜Draft of the Power of Attorney that will be given to the candidate (Applicable for Manager in Charge only).

APA Form (Page – 10/11)

Section 7: REQUIRED DOCUMENTS (Continue)

• ⬜A copy of the draft employment agreement that contains all responsibilities/authorities delegated to the proposed Manager in Charge in detail. There must be a clause in the employment agreement stating that any violation (violation clause) on the part of proposed Manager in Charge will be considered a criminal violation and he/she will be subject to punishment if it is proved that what he/she has signed was incorrect or misleading. It also must include that he/she is responsible for the management of the Licensed Person and is authorized to sign on its behalf (Applicable for Manager in Charge only).
• ⬜An undertaking from the Owner/Partners/Shareholders of the Licensed Person that all its correspondence addressed to the Central Bank must be signed by person(s) authorized to sign on its behalf, along with the full name of such person(s) and the designation(s). Enclose copies of the official power of attorney issued to such person(s).
• ⬜An undertaking letter from the Owner/Partners/Shareholders of the Licensed Person to comply with Paragraphs 16.4.6, 16.4.7 and 16.4.8 of the Standards (Applicable for Compliance Officer only).
• ⬜An undertaking letter from the Owner/Partners/Shareholders of the Licensed Person to comply with Paragraphs 16.5.1 (a) to (g) of the Standards (Applicable for Alternate Compliance Officer only).

APA Form (Page – 11/11)

Section 8: DECLARATION

We declare that the information contained in and submitted along with this Form is complete and accurate to the best of our knowledge and that there are no other relevant facts that the Central Bank must be aware of.

We understand that providing any information to the Central Bank that is false or misleading may result in declining the application or, if discovered later, the subsequent cancellation of any approvals provided. We shall also inform the Central Bank of any material changes to pertinent information contained in the Form that may arise during the application process. We authorize the Central Bank to make such enquiries and seek further information it deems necessary whilst considering this application.

The above declaration must be signed by at least two Directors of the Board. In the absence of the Board of Directors, the above declaration must be signed by the Owner, two major Partners, or two major Shareholders.