anti-money laundering regis1

Anti-Money Laundering Registration FormBefore Completing This Form:

We advise that you refer to Anti-Money Laundering (AML) Registration Guidance on completion of the registration form (the guidance) when completing this form, particularly for questions marked *. You must answer all questions relevant to your business.

Please check that the Office of Fair Trading is your anti-money laundering supervisor. You can find details on who your supervisor is on our website www.oft.gov.uk/mlr

Part 1 Basic Business Information

1a Legal classification of business

Sole Trader Partnership Private Limited Company

Public Limited Company Limited Liability Partnership

If you are a sole trader or partnership go to question 1b. If you are an incorporated company go to question 1c.

1b Owner/s of the business (attach list if more space is required)

1c Name of business*

1d Company registration number (if applicable)

1e Registered office address/address to which legal papers can be served*

Building number/name

Address line 1

Address line 2

Town Postcode

Page 1 of 6

Anti-Money Laundering Registration Form

1f Is your business a franchise? Yes No

1g List other business trading names (attach list if more space is required)*

1h Principal business address (if different to registered office)


Address line 1

Address line 2

Town Postcode

1i Telephone number 1j Fax number

1k Annual turnover* 1l Total number of staff*

1m Number of premises/locations from which the business operates*

1n Provide details of additional premises (enter on page 3)*

1o Have you applied to the OFT for a Consumer Credit Licence? Yes No

1p Consumer Credit Licence Number or application number

1q Do you hold membership of estate agency or credit trade associations? (Listed in the guidance)*

Yes No

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Details of additional premises/locations (Question 1n)*use additional sheet if more space required

Building number/name Address Line 1 Address Line 2 Town PostcodeA

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Part 2 Nominated Officer Information*

The nominated officer is the person nominated within the business to make disclosures to the Serious Organised Crime Agency under the proceeds of Crime Act 2002 also referred to as a money laundering

reporting officer (MLRO).

2a Name of the business Nominated Officer

2b Nominated Officer address (if different from principal business address)


Address line 1

Address line 2

Town Postcode

2c Nominated Officer telephone number

2d Nominated Officer fax number

2e Nominated Officer email address

Page 4 of 6


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Part 3 Business Activity Information

3a Type of business Estate agent Consumer credit financial institution

Estate agent and consumer credit financial institution

3b Type of business activity Commercial estate agent Residential estate agent

Home collected credit Pawnbroking

Payday lending Hire purchase or conditional sale

Mail order business Other secured lending

Other unsecured lending

3c Is your business solely face to face? Yes No

3d If no, what type of non face to face business activity is conducted?

Internet Internet only business Mail order Telephone

3e Do you carry on business outside of the full European Economic Area (EEA)? Yes No

Part 4 Payment Information

4a I enclose a cheque for made payable to Office of Fair Trading*See the registration guidance for details of fees.

Please write your reference number (which can be found on the top left hand corner of this form) on the back of your payment and send your completed signed form with payment to:

Anti-Money Laundering (AML) Team Office of Fair Trading PO Box 65813 LONDON EC4P 4FS

(tick all that apply)

For office use only

Application Number:

Date:

Payment enclosed? yes no

Payment amount

Payment type:

Cashiers initials:


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Declaration

Only an authorised official of the company or owner of the business should sign this form. The limited company or owner(s) of the business are ultimately responsible for the accuracy of the information provided on this form. Please make sure you have read and understood all of the form and the guidance before you sign the declaration.

I declare that:

I have authority to sign this form.

I have answered every question and included all relevant details. Where necessary, I have continued my answers to questions 1b , 1g and 1n on a separate piece of paper, which is attached to this form.

The information given is true and complete. I understand that it is an offence to fail to notify the Office of Fair Trading of any material changes or significant inaccuracies in the information submitted within 30 days of the change or discovery of the inaccuracy.

I will provide any further information that the Office of Fair Trading requests pursuant to Regulation 27(3) of the Money Laundering Regulations 2007.

I understand that the provision of information which contains significant inaccuracies or the failure to notify the Office of Fair Trading of any material changes or significant inaccuracies in the information submitted may result in

my application to register being refused

my registration being cancelled

the imposition of a civil penalty or criminal prosecution.

Name

Signature Date

Position in Organisation

Daytime Phone Number

DD/MM/YYYY

Data Protection

The OFT will use the information you supply for the purposes of Anti-Money Laundering supervision under the Money Laundering Regulations 2007. It may also, for the purposes of supervision, obtain information it considers relevant from other sources (for example, other regulatory, enforcement or public authorities). While the Data Protection Act 1998 and section 237 of the Enterprise Act may restrict disclosure of such information, they also allow disclosure for a number of purposes without your further consent. For example, the OFT may use the information in connection with enforcement or regulatory action it takes under its own powers or may refer the information to other government departments or regulatory, enforcement or public authorities in connection with the exercise of their functions.

Published by the Office of Fair Trading Product code OFT1090a Edition 07/2009 Crown copyright 2009


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