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__________________________________________________________________________ IID 10 of 1999 – 7/03/02 1 Insurance Intermediaries Directive 10 of 1999 Particulars of Companies to be Entered in the Brokers List Directive pursuant to section 7 of the Act 1. (1) This Insurance Intermediaries Directive on the particulars of companies that are to be entered in the Brokers List in relation to the enrolment of companies carrying on business as insurance brokers (“this Directive”) is made by the Centre pursuant to, and for the purposes of, section 7 of the Act. (2) This Directive shall come into force on the 3 rd May 1999 provided that, in the case of an authority holder, the date may extend till not later than the 1 st July 1999. Application 2. This Directive applies to a company desirous of applying for enrolment and, on continuing basis, to a company enrolled, in the Brokers List and carrying on business as insurance broker (the “enrolled company”). Scope 3. The scope of this Directive is to determine - (a) the particulars of companies that are to be entered in the Brokers List in relation to the enrolment of companies desirous of carrying on, or carrying on, business as insurance brokers; (b) the manner in which such companies shall make application to the Centre for enrolment in the Brokers List. Particulars of companies to be entered in the Brokers List
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Insurance Intermediaries Directive 10 of 1999ec.europa.eu/internal_market/finances/docs/actionplan/...IID 10 of 1999 – 7/03/02 4 D: Management D1. Names of officers and controllers.

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Page 1: Insurance Intermediaries Directive 10 of 1999ec.europa.eu/internal_market/finances/docs/actionplan/...IID 10 of 1999 – 7/03/02 4 D: Management D1. Names of officers and controllers.

__________________________________________________________________________ IID 10 of 1999 – 7/03/02 1

Insurance Intermediaries Directive 10 of 1999

Particulars of Companies to be Entered in the Brokers List

Directive pursuant to section 7 of the Act

1. (1) This Insurance Intermediaries Directive on the particulars

of companies that are to be entered in the Brokers List in relation to the enrolment of companies carrying on business as insurance brokers (“this Directive”) is made by the Centre pursuant to, and for the purposes of, section 7 of the Act.

(2) This Directive shall come into force on the 3rd May 1999

provided that, in the case of an authority holder, the date may extend till not later than the 1st July 1999.

Application 2. This Directive applies to a company desirous of applying for

enrolment and, on continuing basis, to a company enrolled, in the Brokers List and carrying on business as insurance broker (the “enrolled company”).

Scope

3. The scope of this Directive is to determine -

(a) the particulars of companies that are to be entered in the Brokers List in relation to the enrolment of companies desirous of carrying on, or carrying on, business as insurance brokers;

(b) the manner in which such companies shall make

application to the Centre for enrolment in the Brokers List.

Particulars of companies to be entered in the Brokers List

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__________________________________________________________________________ IID 10 of 1999 – 7/03/02 2

4. In relation to the enrolment of companies desirous of carrying

on, or carrying on, business as insurance brokers, the other particulars to be entered in the Brokers List as determined by this Directive for the purpose of section 7 of the Act are -

(a) where the company is a local company, those set out in the

First Schedule to this Directive; (b) where the company is a foreign company, those set out in

the Second Schedule to this Directive.

Manner of application for enrolment

5. The manner in which a company shall make application to the Centre for enrolment in the Brokers List under section 13 of the Act as determined by this Directive for the purpose of section 7 of the Act is -

(a) where the company is a local company, in Form 2 as set

out in the Third Schedule to this Directive; (b) where the company is a foreign company, in Form 3 as set

out in the Fourth Schedule to this Directive.

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__________________________________________________________________________ IID 10 of 1999 – 7/03/02 3

F I R S T S C H E D U L E

(Article 4)

Insurance Brokers and Other Intermediaries Act, 1998 (Section 7)

The Brokers List

Enrolment of local companies carrying on business as insurance brokers

Particulars to be provided A: Company details A1. Name of company. A2. Date of registration under the Companies Act, 1995 (day/month/year). A3. Registration number. A4. Address of registered office. A5. Name of company secretary. A6. Names of shareholders (individuals or entities, indicating qualifying

shareholders). A7. Name of approved auditors. B: Connected Persons B1. Particulars of connected persons (individuals or entities). C: Registered insurance broker/s (Head Office) C1. Name/s of registered insurance broker/s. C2. Status of broker/s (that is to say whether director or employee of the

company). C3. Certificate/s of registration number/s.

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__________________________________________________________________________ IID 10 of 1999 – 7/03/02 4

D: Management D1. Names of officers and controllers. E: Principal place of business E1. Address of principal place of business in Malta (if not the same as A4). E2. Business telephone number/s. E3. Business fax number/s. F: Branch or branches F1. Address or addresses of branch or branches. F2. Business telephone number/s. F3. Business fax number/s.

G: Registered insurance broker/s (Branch/es) G1. Name/s of registered insurance broker/s. G2. Status of broker/s (that is to say whether director or employee of the

company). G3. Certificate/s of registration number/s. H: Professional Indemnity Hl. Amount of cover. H2. Excess amount. I: Enrolment I1. Date of enrolment (day/month/year). I2. Enrolled number.

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__________________________________________________________________________ IID 10 of 1999 – 7/03/02 5

S E C O N D S C H E D U L E

(Article 4)

Insurance Brokers and Other Intermediaries Act, 1998 (Section 7)

The Brokers List Enrolment of foreign companies carrying on business as insurance brokers

Particulars to be provided A: Company details A1. Name of company. A2. Date of registration, incorporation or constitution under the laws of the

country where its head office is situated (day/month/year). A3. Number of registration, incorporation or constitution. A4. Address of registered office. A5. Name of company secretary. A6. Name of qualifying shareholders (individuals or entities indicating

qualifying shareholders). B: Connected persons B1. Particulars of connected persons (individuals or entities and whether

foreign or Maltese) C: Authorisation/permission to carry on business as insurance broker in

the country of registration, etc. C1. Authorisation /permission number.

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D: The Malta branch D1. Name of company. D2. Date of registration under the Companies Act, 1995 (day/month/year). D3. Registration number. D4. Address of registered office. E: Registered insurance broker/s (Branch) E1. Name/s of registered insurance broker/s. E2. Status of broker/s (that is to say whether director or employee of the

company). E3. Certificate/s of registration number/s. F: Company representative F1. (where the representative is an individual) F1.1. Full name (surname/forename/s including title and name by which

commonly known). F1.2. Any previous names by which known (including name before marriage). F1.3. Identity Card number. F1.4. Business telephone number/s. F1.5. Business fax number/s. F2. (where the representative is not an individual) F2.1. Name of body corporate. F2.2. Date of registration under the Companies Act, 1995 (day/month/year). F2.3. Registration number. F2.4. Address of registered office.

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__________________________________________________________________________ IID 10 of 1999 – 7/03/02 7

F2.5. Address of principal place of business (if not the same as F2.4.). F2.6. Business telephone number/s. F2.7. Business fax number/s. F2.8. Full name of the individual representative (surname/forename/s including

title and name by which commonly known). F2.9. Any previous name by which known (including name before marriage). F2.10. Business address or addresses. F2.11. Identity Card number. F2.12. Business telephone number/s. F2.13. Business fax number/s. G: Management G1. Names of officers and controllers. H: Principal place of business H1. Address of principal place of business in Malta (if not the same as A4.). H2. Business telephone number/s. H3. Business fax number/s. I: Other places of business I1. Address or addresses of other place or places of business in Malta. I2. Business telephone number/s. I3. Business fax number/s. J: Registered insurance broker/s (Other place/s of business)

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J1. Name/s of registered insurance broker/s. J2. Status of broker/s (that is to say whether director or employee of the

company). J3. Certificate/s of registration number/s.

K: Professional Indemnity K1. Amount of cover. K2. Excess amount. L: Fidelity Bond L1. Form - L1.1. Contract of insurance. L1.2. Bank guarantee. L1.3. Bank letter of credit. L2. Approved person L2.1. (where the approved person is an individual) L2.1.1. Full name (surname / forename/s including title and name by which

commonly known). L2.1.2. Any pervious names by which known (including name before marriage). L2.1.3. Identity Card number. L2.1.4. Business telephone number/s. L2.1.5. Business Fax number/s. L2.2. (where the approved person is not an individual) L2.2.1. Name of body corporate.

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__________________________________________________________________________ IID 10 of 1999 – 7/03/02 9

L2.2.2. Date of registration under the Companies Act, 1995 (day/month/year). L2.2.3. Registration number. L2.2.4. Address of registered office. L2.2.5. Address of principal place of business (if not the same as L2.2.4.). L2.2.6. Business telephone number/s. L2.2.7. Business Fax number/s. L2.2.8. Full name of individual nominated person (surname / forename/s including

title and name by which commonly known). L2.2.9. Any previous name by which known (including name before marriage). L2.2.10. Identity Card number. M: Enrolment

M1. Date of enrolment (day/month/year). M2. Enrolled number.

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__________________________________________________________________________ IID 10 of 1999 – 7/03/02 10

T H I R D S C H E D U L E

(Article 5) Form 2

Insurance Brokers and Other Intermediaries Act, 1998 (Section 13)

Application for enrolment of local companies in the Brokers List

Chief Executive Malta Financial Services Centre I hereby apply for enrolment in the Brokers List under section 13 of the Insurance Brokers and Other Intermediaries Act, 1998 of the company whose particulars are given hereunder. An application for enrolment fee in accordance with regulations governing fees made under the Act is made by cheque No. _________ , enclosed, payable to the Malta Financial Services Centre. Particulars of the company relevant to this application are provided herein. A: Company details (Note 1) A1. Name of company:- ___________________________

A2. Date of registration under the

Companies Act, 1995 (day/month/year):-

___________________________

A3. Registration number:-

___________________________

A4. Address of registered office

including Post Code:-

___________________________ ___________________________ ___________________________

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A5. Name of company secretary:- ___________________________ A6. Name of approved auditors:-

___________________________

A7. Name of the company’s principal

bankers:- A7.1. Address including Post Code:-

___________________________ ___________________________ ___________________________ ___________________________ ___________________________

A7.2. Business telephone number/s:-

___________________________

A7.3. Business fax number/s:-

___________________________

A8. Name of the company’s legal consultants:-

A8.1. Address including Post Code:-

___________________________ ___________________________ ___________________________ ___________________________ ___________________________

A8.2. Business telephone number/s:-

___________________________

A8.3. Business fax number/s:-

___________________________

A9. Date on which the company’s

financial year will end:-

___________________________

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B: Qualifying shareholders and percentage sizes of holdings or voting rights (Note 2)

B1. Individual shareholders:- Name:- Identity Card number:- Address including Post Code:- Proportion and form of voting

rights/share capital held:- Name:- Identity Card number:- Address including Post Code:- Proportion and form of voting

rights/share capital held:-

(1)________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ (2)________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________

B2. Body corporate shareholders:- Name:- Registration number:-

Address of registered office

(1)________________________ ___________________________

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__________________________________________________________________________ IID 10 of 1999 – 7/03/02 13

including Post Code:- Proportion and form of voting

rights/share capital held:- Name:- Registration number:- Address of registered office

including Post Code:- Proportion and form of voting

rights/share capital held:-

___________________________ ___________________________ ___________________________ ___________________________ (2)________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________

C: Directors and Management (Note 3) C1. Names of persons who are

directors, controllers or managers of the company and their position:-

___________________________ ___________________________ ___________________________ ___________________________

D: Connected persons (Note 4) D1. Name/s of connected person/s

within the meaning of Insurance Intermediaries Directive 3 of 1999:-

___________________________ ___________________________ ___________________________ ___________________________

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E: Principal place of business E1. Address of principal place of

business including Post Code (if not the same as A4.):-

___________________________ ___________________________ ___________________________ ___________________________

E2. Business telephone number/s:-

___________________________

E3. Business fax number/s:-

___________________________

F: Registered insurance broker/s (Principal place of business) F1. Name/s and status of registered

insurance broker/s (status means whether director (D) or employee (E) of the company):-

(1)________________________ (2)________________________ (3)________________________

F2. Certificate/s of registration

number/s:-

(1)________________________ (2)________________________ (3)________________________

G: Branch or branches G1. Address or addresses of branch or

branches including Post Code:-

___________________________ ___________________________ ___________________________ ___________________________

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__________________________________________________________________________ IID 10 of 1999 – 7/03/02 15

G2. Business telephone number/s:- ___________________________

G3. Business fax number/s:-

___________________________

H: Registered insurance broker/s (Branch/es) H1. Name/s and status of registered

insurance broker/s (status means whether director (D) or employee (E) of the company):-

(1)________________________ (2)________________________ (3)________________________

H2. Certificate/s of registration

number/s:-

(1)________________________ (2)________________________ (3)________________________

I: Professional Indemnity (Note 5) I1. Amount of cover:-

___________________________

I2. Amount of excess:-

___________________________

J: Fidelity Bond (Note 6) J1. Form (please tick) J1.1. Contract of insurance:-

J1.2. Guarantee provided by a bank or

credit institution:-

J1.3. Letter of credit established with a

bank or credit institution:-

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J2. Nomination of approved person to administer the fidelity bond J2.1. (where the approved person is an individual) J2.1.1. Surname:- ___________________________

Forename/s:-

___________________________

Title:-

___________________________

Name commonly known by:-

___________________________

Any previous name/s by which

known (including name before marriage):-

J2.1.2. Identity Card number:-

___________________________ ___________________________

J2.1.3. Business Address including Post

Code:-

___________________________ ___________________________ ___________________________

J2.1.4. Business telephone number/s:-

___________________________

J2.1.5. Business fax number/s:-

___________________________

J2.2. (where the approved person is not an individual) J2.2.1. Name of body corporate:-

___________________________

J2.2.2. Date of registration under the

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Companies Act, 1995 (day/month/year):-

___________________________

J2.2.3. Registration number:-

___________________________

J2.2.4. Address of registered office

including Post Code:-

___________________________ ___________________________ ___________________________ ___________________________

J2.2.5. Address of principal place of

business including Post Code (if not the same as J2.2.4.):-

___________________________ ___________________________ ___________________________ ___________________________

J2.2.6. Business telephone number/s:-

___________________________

J2.2.7. Business fax number/s:-

___________________________

The particulars provided in this application and the documents produced with it are complete and true to the best of my knowledge, information and belief. I hereby authorise the Centre to contact any or all of the above-named or any other person considered by the Centre to be relevant, both at the date of application and at any time in the future unless and until I rescind this authority in writing. I also undertake to inform the Centre in writing of any material change relevant to this application. Signed _______________________ Position ______________________ Date __________________

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For official use K: Enrolment K1. Date of enrolment (day/month/year):- K2. Enrolled number:-

____________________________ ____________________________

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When filling in the application form, if more space is needed to fill in any details or to supply any information required by the form, please add continuation sheets at the back of the form and mark each sheet with the section appropriate to the details given or information supplied. The person who signs the application form shall initial each page including any continuation sheet. Any reference in the application form and these notes to the Personal Questionnaire means a reference to the Personal Questionnaire as set out in the Appendix to Insurance Intermediaries Directive 21 of 1999. Notes 1. All particulars required by the application form are in respect of a limited liability

company formed and registered under the Companies Act, 1995.

Where an applicant is a company in formation, details required by the application form which are not available at the time of submission are to be provided as soon as these are available.

Where an applicant is a partnership en commandite, the capital of which is divided into shares, formed and registered under the Companies Act, 1995, the applicant shall inform the Centre of that fact and the Centre shall provide the applicant with the necessary modifications to the application form.

2. Where qualifying shareholders are individuals, a Personal Questionnaire should be

submitted by each individual. Where the applicant has or will have one or more qualifying shareholders, or if the

applicant holds or will hold a qualifying shareholding in one or more companies, a diagram of the group family tree should be attached.

Note: The family tree should give details up to the ultimate beneficial owner/s,

showing percentage size of holdings in each entity unless (a) the entity has one ultimate beneficial owner with a holding of over 50% of the voting rights or (b) no less than fifty ultimate beneficial owners can between them account for over 50% of the voting rights. In either case (a) or (b) it will only be necessary to give details of the ultimate beneficial owners with holdings of 10% or more.

3. A Personal Questionnaire should be submitted for each director, controller and

manager. 4. Please attach a diagram illustrating the connection in respect of each connected

person.

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5. Please attach a quotation of a policy of professional indemnity insurance which should conform with the requirements of the Professional Indemnity Insurance Guidelines in the case of an enrolled company issued for such purpose by the Centre and set out as an Appendix immediately after the Fourth Schedule to the Directive.

6. Please attach a copy of the fidelity bond (in draft form) to be approved by the

Centre. Documentation Please provide the following documentation: 1. Memorandum and articles of association of the company. 2. A statement showing the components making up the own funds of the company

and the assets covering such funds within the meaning of Insurance Intermediaries Directive 1 of 1999.

3. A scheme of operations relating to the proposed business of insurance broking

within the meaning of Insurance Intermediaries Directive 12 of 1999. 4. Draft copies of any underwriting agreements which the company proposes to make

or enter into with any authorised company or insurance agent pursuant to section 43 of the Act and in accordance with Insurance Intermediaries Directive 20 of 1999.

5. Updated police conduct certificate in respect of each director, controller and

manager of the company.

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F O U R T H S C H E D U L E (Article 5) Form 3

Insurance Brokers and Other Intermediaries Act, 1998 (Section 13)

Application for enrolment of foreign companies in the Brokers List

Chief Executive Malta Financial Services Centre I hereby apply for enrolment in the Brokers List under section 13 of the Insurance Brokers and Other Intermediaries Act, 1998 of the company whose particulars are given hereunder. An application for enrolment fee in accordance with regulations governing fees made under the Act is made by cheque No. _________ , enclosed, payable to the Malta Financial Services Centre. Particulars of the company relevant to this application are provided herein. A: Company details (Note 1) A1. Name of company:- ___________________________

A2. Date of registration, incorporation

or constitution under the laws of the country where its head office is situated (day/month/year):-

___________________________

A3. Registration, incorporation or

constitution number:-

___________________________

A4. Address of registered office

including Post Code:-

___________________________ ___________________________ ___________________________

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A5. Name of company secretary:-

___________________________

A6. Name of the company’s auditors:- A6.1. Address including Post Code:-

___________________________ ___________________________ ___________________________ ___________________________ ___________________________

A6.2. Business telephone number/s:-

___________________________

A6.3. Business fax number/s:-

___________________________

A7. Name of the company’s principal

bankers:- A7.1. Address including Post Code:-

___________________________ ___________________________ ___________________________ ___________________________ ___________________________

A7.2. Business telephone number/s:-

___________________________

A7.3. Business fax number/s:-

___________________________

A8. Name of the company’s legal consultants:-

A8.1. Address including Post Code:-

___________________________ ___________________________

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___________________________ ___________________________ ___________________________

A8.2. Business telephone number/s:-

___________________________

A8.3. Business fax number/s:-

___________________________

A9. Date on which the company’s

financial year ends:-

___________________________

B: Qualifying shareholders and percentage sizes of holdings or voting rights

(Note 2) B1. Individual shareholders:- Name:- Passport number:- Address including Post Code:- Proportion and form of voting

rights/share capital held:- Name:- Passport number:- Address including Post Code:-

(1)________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ (2)________________________ ___________________________ ___________________________

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Proportion and form of voting

rights/share capital held:-

___________________________ ___________________________ ___________________________

B2. Body corporate shareholders:- Name:- Registration, incorporation or

constitution number:- Address of registered office

including Post Code:- Proportion and form of voting

rights/share capital held:- Name:- Registration, incorporation or

constitution number:- Address of registered office

including Post Code:- Proportion and form of voting

rights/share capital held:-

(1)________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ (2)________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________

C: Directors and Management (Note 3) C1. Names of persons who are ___________________________

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directors, controllers or vested with the administration of the company and their position:-

___________________________ ___________________________ ___________________________

D: Connected persons (Note 4) D1. Name/s of connected person/s

within the meaning of Insurance Intermediaries Directive 3 of 1999 relevant to the applicant’s business of insurance broking in Malta:-

___________________________ ___________________________ ___________________________ ___________________________

E: Authorisation/permission to carry on business as insurance broker in the

country of registration, incorporation or constitution E1. Authorisation/permission

number:-

___________________________

F: The Malta Branch (Note 5) F1. Date of registration as an oversea

company under the Companies Act, 1995 (day/month/year):-

___________________________

F2. Registration number:-

___________________________

F3. Address of registered office

including Post Code:-

___________________________ ___________________________ ___________________________

F4. Name of the company’s principal

bankers:- F4.1. Address including Post Code:-

___________________________ ___________________________

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___________________________ ___________________________

F4.2. Business telephone number/s:-

___________________________

F4.3. Business fax number/s:-

___________________________

F5. Name of approved auditors:-

___________________________

F6. Principal place of business F6.1. Address of principal place of

business in Malta including Post Code (if not the same as F3.):-

___________________________ ___________________________ ___________________________ ___________________________

F6.2. Business telephone number/s:-

___________________________

F6.3. Business fax number/s:-

___________________________

F7. Other place/s of business F7.1. Address or addresses of other

place or places of business in Malta including Post Code:-

___________________________ ___________________________ ___________________________

F7.2. Business telephone number/s:-

___________________________

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F7.3. Business fax number/s:- ___________________________

G: Registered insurance broker/s (Principal place of business) G1. Name/s and status of registered

insurance broker/s (status means whether director (D) or employee (E) of the company):-

(1)________________________ (2)________________________ (3)________________________

G2. Certificate/s of registration

number/s:-

(1)________________________ (2)________________________ (3)________________________

H: Registered insurance broker/s (Other place/s of business) H1. Name/s and status of registered

insurance broker/s (status means whether director (D) or employee (E) of the company):-

(1)________________________ (2)________________________ (3)________________________

H2. Certificate/s of registration

number/s:-

(1)________________________ (2)________________________ (3)________________________

I. Company representative in Malta I1. (where the representative is an individual)

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I1.1. Surname:-

___________________________

Forename/s:-

___________________________

Title:-

___________________________

Name commonly known by:-

___________________________

Any previous name/s by which known (including name before marriage):-

I1.2. Identity Card number:-

___________________________ ___________________________

I1.3. Business Address including Post Code:-

___________________________ ___________________________ ___________________________

I1.4. Business telephone number/s:-

___________________________

I1.5. Business fax number/s:-

___________________________

I2. (where the representative is not an individual) I2.1. Name of body corporate:- ___________________________

I2.2. Date of registration under the

Companies Act, 1995 (day/month/year):-

___________________________

I2.3. Registration number:-

___________________________

I2.4. Address of registered office

including Post Code:-

___________________________ ___________________________

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___________________________ ___________________________

I2.5. Address of principal place of

business including Post Code (if not the same as I2.4.):-

___________________________ ___________________________ ___________________________ ___________________________

I2.6. Business telephone number/s:-

___________________________

I2.7. Business fax number/s:-

___________________________

I2.8. (individual representative of the representative body corporate) I2.8.1. Surname:-

___________________________

Forename/s:-

___________________________

Title:-

___________________________

Name commonly known by:-

___________________________

Any previous name/s by which known (including name before marriage):-

I2.8.2. Identity Card number:-

___________________________ __________________________

I2.8.3. Business Address including Post

Code:-

___________________________ ___________________________

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___________________________

I2.8.4. Business telephone number/s:-

___________________________

I2.8.5. Business fax number/s:-

___________________________

J: Professional Indemnity (Note 6) J1. Amount of cover:-

___________________________

J2. Amount of excess:-

___________________________

K: Fidelity Bond (Note 7) K1. Form (please tick) K1.1. Contract of insurance:-

K1.2. Guarantee provided by a bank or

credit institution:-

K1.3. Letter of credit established with a

bank or credit institution:-

K2. Nomination of approved person to administer the fidelity bond K2.1. (where the approved person is an individual) K2.1.1. Surname:-

___________________________

Forename/s:-

___________________________

Title:-

___________________________

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Name commonly known by:-

___________________________

Any previous name/s by which known (including name before marriage):-

K2.1.2. Identity Card number:-

___________________________ ___________________________

K2.1.3. Business Address including Post

Code:-

___________________________ ___________________________ ___________________________

K2.1.4. Business telephone number/s:-

___________________________

K2.1.5. Business fax number/s:-

___________________________

K2.2. (where the approved person is not an individual) K2.2.1. Name of body corporate:-

___________________________

K2.2.2. Date of registration under the

Companies Act, 1995 (day/month/year):-

___________________________

K2.2.3. Registration number:-

___________________________

K2.2.4. Address of registered office

including Post Code:-

___________________________ ___________________________ ___________________________

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___________________________

K2.2.5. Address of principal place of

business including Post Code (if not the same as K2.2.4.):-

___________________________ ___________________________ ___________________________ ___________________________

K2.2.6. Business telephone number/s:-

___________________________

K2.2.7. Business fax number/s:-

___________________________

The particulars provided in this application and the documents produced with it are complete and true to the best of my knowledge, information and belief. I hereby authorise the Centre to contact any or all of the above-named or any other person considered by the Centre to be relevant, both at the date of application and at any time in the future unless and until I rescind this authority in writing. I also undertake to inform the Centre in writing of any material change relevant to this application. Signed _______________________ Position ______________________ Date __________________ For official use L: Enrolment

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L1. Date of enrolment (day/month/year):- L2. Enrolled number:-

____________________________ ____________________________

When filling in the application form, if more space is needed to fill in any details or to supply any information required by the form, please add continuation sheets at the back of the form and mark each sheet with the section appropriate to the details given or information supplied. The person who signs the application form shall initial each page including any continuation sheet. Any reference in the application form and these notes to the Personal Questionnaire means a reference to the Personal Questionnaire as set out in the Appendix to Insurance Intermediaries Directive 21 of 1999.

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Notes 1. Where an applicant is a partnership en commandite, the capital of which is divided

into shares, formed and registered or incorporated or constituted under the laws of the country of its head office, the applicant shall inform the Centre of that fact and the Centre shall provide the applicant with the necessary modifications to the application form.

2. Where qualifying shareholders are individuals, a Personal Questionnaire should be

submitted by each individual. Where the applicant has or will have one or more qualifying shareholders, or if the

applicant holds or will hold a qualifying shareholding in one or more companies, a diagram of the group family tree should be attached.

Note: The family tree should give details up to the ultimate beneficial owner/s,

showing percentage size of holdings in each entity unless (a) the entity has one ultimate beneficial owner with a holding of over 50% of the voting rights or (b) no less than fifty ultimate beneficial owners can between them account for over 50% of the voting rights. In either case (a) or (b) it will only be necessary to give details of the ultimate beneficial owners with holdings of 10% or more.

3. A Personal Questionnaire should be submitted for each director, controller or

person vested with the administration of the branch of the company. 4. Please attach a diagram illustrating the connection relevant to the applicant’s

proposed business of insurance broking in Malta in respect of each connected person.

5. The applicant shall provide the Centre with the list of particulars required to be

provided to the Registrar of Companies under the Companies Act, 1995. 6. Please attach a quotation of a policy of professional indemnity insurance in relation to

applicant’s organisation in Malta which should conform with the requirements of the Professional Indemnity Insurance Guidelines in the case of an enrolled company issued for such purpose by the Centre and set out as an Appendix immediately after this Schedule. Where the applicant has in force a group policy of professional indemnity insurance, the Centre may accept such policy as a policy satisfying the requirements of the Guidelines and the Act in that respect provided that Malta is included in the geographical area covered by the policy.

7. Please attach a copy of the fidelity bond (in draft form) to be approved by the Centre. Documentation Please provide the following documentation:

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1. Memorandum and articles of association of the company or any other instrument of

registration, incorporation or constitution of the company. 2. An attested copy of the original certificate of registration, incorporation or constitution of

the company. 3. A company profile outlining ownership up to the ultimate beneficial owner/s, lines of

business, subsidiaries/associates and geographical spread. 4. Balance sheet and profit and loss accounts of the company for each of the last three

financial years, or, if the company has not been in business for three financial years, for each of the financial years for which it has been in business.

5. A statement showing the components making up the own funds of the company and the

assets covering such funds within the meaning of Insurance Intermediaries Directive 1 of 1999.

6. A scheme of operations relating to the proposed business of insurance broking in Malta

within the meaning of Insurance Intermediaries Directive 12 of 1999. 7. Draft copies of any underwriting agreements which the company proposes to make or

enter into in Malta with any authorised company or insurance agent pursuant to section 43 of the Act and in accordance with Insurance Intermediaries Directive 20 of 1999.

8. Updated police conduct certificate in respect of each officer of the company of Maltese

nationality. 9. Documentation evidencing authorisation/permission to carry on business of insurance

broking in the country of registration, incorporation or constitution of applicant.

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Appendix

(Notes 5 and 6 respectively of the Third and Fourth Schedules)

Professional Indemnity Insurance Guidelines

- In the case of an Enrolled Company - 1.0 Preliminary 1.1 Section 8(f) of the Insurance Brokers and Other Intermediaries Act, 1998 (“the

Act”) requires a company desirous of applying for enrolment and, on continuing basis, a company enrolled in the Brokers List and carrying on business as insurance broker (the “enrolled company”) to have in its favour a policy of professional indemnity insurance acceptable to the Centre, indemnifying it, or any person employed by it, or otherwise acting for it, to such amount in such manner and in respect of such matters as the Centre may, from time to time, determine.

2.0 Definitions 2.1 In these Guidelines, unless otherwise defined, the words and expressions which

are also used in the Act have the same meanings as in the Act. 3.0 Matters concerning Professional Indemnity Insurance 3.1 In the case of a company desirous of applying for enrolment or an enrolled

company, cover is required for legal liability in consequence of any negligent act, error or omission in the conduct of its business as an insurance broker or of any person employed by it or otherwise acting for it, including consultants under a contract for service with the enrolled company.

3.2 Without prejudice to the generality of the foregoing provisions, the policy shall

indemnify the enrolled company against claims arising from:

(a) a dishonest, fraudulent, criminal or malicious act, error or omission of any person at any time employed by the enrolled company, or otherwise acting for it, including consultants under a contract for service with the enrolled company;

(b) libel, slander and defamation;

(c) loss of and damage to documents and records belonging to the enrolled company or which are in its care, custody or control or for which it is

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responsible; including also documents and records stored on magnetic or electronic media and liability and costs and expenses incurred in replacing, restoring or reconstructing the documents or records and consequential loss resulting from the loss or damage to the documents or records;

(d) liability resulting from any breach of a provision of the Act, or the

Insurance Business Act, 1998 or any regulation made under those Acts, or any Insurance Intermediaries Directive or Insurance Directive issued in virtue of any of the Acts and any award resulting from any such breach;

(e) claims made after expiry of the policy where the circumstances giving rise

to the claim were notified to the insurers during the period of the policy. 3.3 The required minimum limits of indemnity shall be not less than Lm250,000 in

respect of each and every claim or series of claims arising out of the same occurrence.

Legal costs and expenses are to be covered in addition. . 3.4 The excess shall be:

(i) 25% of the company’s net liquid resources; or (ii) the amount by which the issued and paid up share capital of the

company exceeds Lm25,000, in every case whichever is the lower and subject to a maximum of Lm10,000. (iii) Lm1,000, where the company does not satisfy the net liquid resources or does not have any excess capital.

“Net liquid resources” means the current assets less the current liabilities of the

company as at the last audited financial statements.

The Centre may, on application made to it in writing by the enrolled company demonstrating that the company is unable to secure in its favour a policy of professional indemnity insurance policy satisfying the excess as determined in this paragraph (“the required excess”), permit that the company takes out a bank guarantee equal to the amount resulting from the difference between the amount of the excess requested by the insurer underwriting the policy and the required excess. The wording of the bank guarantee is to be approved in advance by the Centre.

3.5 The policy shall be governed by Maltese law.

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4.0 For the purposes of demonstrating to the satisfaction of the Centre that the requirements of paragraph 3 above are being complied with, the enrolled company shall submit to the Centre a copy of the policy or renewed receipt, as the case may be, or a copy of the cover note, or such other written evidence as the Centre may require to establish compliance with these Guidelines.

5.0 An enrolled company shall within two working days from the date it becomes aware of any of the circumstances specified in (i) to (vi) below, inform the Centre in writing where: (i) during the currency of a policy the enrolled company has notified

insurers of an incident which may give rise to a claim under the policy; (ii) during the currency of a policy the insurer has avoided or cancelled the

policy or has notified his intention of doing so; (iii) the policy has not been renewed or has been cancelled and another

policy satisfying the provisions of these Guidelines has not been taken out from the date on which the previous policy lapsed or was cancelled;

(iv) during the currency of a policy the terms or conditions of the policy are

altered in any manner so that the policy no longer satisfies the requirements of these Guidelines;

(v) the insurer has intimated that he intends to decline to indemnify the

insured in respect of a claim under the policy; (vi) the insurer has given notice that the policy will not be renewed or will

not be renewed in a form which will enable the policy to satisfy the requirements of these Guidelines;

(vii) during the currency of a policy the risks covered by the policy, or the

conditions or terms relating thereto, are altered in any manner. 6.0 The professional indemnity policy taken out by an enrolled company may with

the written consent of the Centre be extended to cover any licensable activity, service or business subject that the requirements of paragraph 3 above are complied with.

7.0 Savings

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7.1 These are general guidelines. However, the Centre may require a company desirous of applying for enrolment, and on a continuing basis, an enrolled company to have a policy of professional indemnity of such higher amount, or in such manner and in respect of such matters as the Centre may deem appropriate for the kind of business intended to be carried on, or is being carried on, by the company.