LICENSING APPLICATION FORM



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Form Q16

Application for a Temporary Permit

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|Firm Name: | |      |

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|Date of Submission: | |      |

|Please submit this form to: | | |

|QFC Regulatory Authority | | |

|Regulatory Services | | |

|Level 14, QFC Tower | | |

|PO Box 22989 | | |

|Doha, Qatar | | |

|Tel: +974 44956888 | | |

|Fax: +974 44835031 | | |

|Email: rs@ | | |

| | |For Regulatory Authority Use |

| |Reference No: | |

| |Date received: | |

| |Received by: | |

Background and purpose of this form

Form Q16 ‘Application for a Temporary Permit’ should be completed by all firms who have filed or are contemplating filing an application for a Qatar Financial Centre (“QFC”) Licence issued by the QFC Authority or Authorisation issued by the QFC Regulatory Authority and who for a period of time not to exceed three months wish to relocate certain of their employees (and agents) in Qatar to engage in specified preliminary activities in furtherance of their application for a Licence or Authorisation and establishment in Qatar. The application is not required to be filed by those Applicants (and their employees and agents) who enter Qatar under normal visit visa arrangements and whose conduct and activities otherwise would not require a QFC Licence or Authorisation. This Temporary Permit can be extended once for a period not to exceed three months.

The types of activities which may be conducted under this Temporary Permit include those matters related to:

• Operations – establishing a physical presence in Doha, including premises for the firm and its staff; staff recruitment etc;

• Market Research – examining the business case in Qatar, gathering market information, undertaking market research etc; and

• Issuance of Licence/Authorisation - facilitating the review of their applications by the QFC Regulatory Authority.

The specific types of activity proposed to be undertaken in Qatar under the terms of this Temporary Permit must be detailed in full in Section 4 and may only be undertaken pursuant to the general terms and conditions set forth in Appendix 1 to this Form and any other conditions that the QFC Authority may impose as a condition of issuing this Temporary Permit. Any such conditions shall form a part of the Temporary Permit and any false or misleading information contained herein, or the failure to comply with any term or condition of the Temporary Permit may provide the basis for revocation of the Temporary Permit as well as the denial of, or the imposition of conditions on, any QFC Licence or Authorisation.

Applicant Firms shall note that the granting of any Temporary Permit does not constitute the issuance of a QFC Authority Licence, for which Form Q01, ‘Application for a Licence to Conduct Non-regulated Activities’, must be filed, or of a QFC Regulatory Authority Authorisation, for which Form Q02, ‘Application for Authorisation to Conduct Regulated Activities’ and Form Q03, ‘Application or Approved Individuals’, must be filed. In particular, an Applicant Firm may not open any new customer accounts during the time its Temporary Permit is in effect or in any way hold itself out as being able to conduct activities that would otherwise require licensing or authorising by the QFC Authority or QFC Regulatory Authority respectively.

Notes for completing this form

• All questions must be answered in full and the use of abbreviations should be avoided.

• Dates must be provided in the following format: dd/mm/yyyy.

• Answers must be typed and additional pages attached if necessary.

• Ensure that any supporting documentation is clearly labelled and securely attached.

• All responses and supporting documentation must be in the English language or accompanied by an appropriate translation into the English language.

Notes for lodging this form

• The method of lodgment of this form is:

• by post or hand delivery to the address of the QFC Regulatory Authority on the front of this form;

• by electronic mail to an address provided by the QFC Regulatory Authority; or

• by fax to a number provided by the QFC Regulatory Authority.

 

• The QFC Regulatory Authority has been appointed to receive documents required to be filed or lodged under QFC legislation with the QFC Authority and the QFC Companies Registration Office and for receiving payment of the applicable fees to those entities.

• Lodgment of this form and its attachments with the QFC Regulatory Authority constitutes lodgment of this form with the QFC Authority.

• The information contained in any lodged form may be shared between the QFC Regulatory Authority, the QFC Authority and the QFC Companies Registration Office under arrangement between them, and in accordance with applicable QFC confidentiality and data protection legislation.

1. CONTACT DETAILS

Please provide details of the principal contact responsible for this form

If additional information is required, the individual identified in this section will be contacted

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1. Name:

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2. Job title:

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3. Office address:

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4. Telephone number:

Include country and area codes

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5. Fax number:

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6. Email address:

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7. Preferred method of contact:

2. IDENTIFICATION OF APPLICANT FIRM

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1. Name of Applicant Firm:

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2. Website:

3. Location from which Applicant Firm proposes to conduct activities under its Temporary Permit:

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4. Legal status of the Applicant Firm (e.g. LLC, LLP or branch):

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5. Place and date of incorporation / formation:

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6. Is the Applicant Firm listed on a Recognised or Approved Stock Exchange? If YES, please specify the stock exchange(s) on which it is listed.

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Yes No

Group structure

7. Please attach a Group structure chart:

The Group structure chart should state the percentage size of the holding held by each Controller. It is important to show all the beneficial owners of Controlling Interests of which the Applicant Firm is aware, or ought reasonably to be aware, including those with an indirect Controlling Interest. Where there is a Parent Entity, the chart must also show details of those shareholders holding 10% or more of the share capital in the Parent Entity. The nature of the activities undertaken by each Controller should be specified.

Where shares are held by a trust, the Applicant Firm must also provide details of all trustees and beneficiaries.

3. IDENTIFICATION OF INDIVIDUALS

This Section must be completed by the Director making the Declaration in Section 6 of this application and each individual who will be conducting the activities identified in Section 4 of this application. Please photocopy this Section and attach additional copies to this Form as required. The QFC Authority or the QFC Regulatory Authority may, based on the facts and circumstances of each Applicant Firm, limit the number of individuals who may be present in Qatar at any particular time under the terms of a Temporary Permit.

Personal Details

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1. Title (Mr/Mrs/Ms/Dr etc):

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2. Surname:

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3. All forenames:

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4. Date of birth:

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5. National identification number:

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6. Previous name(s):

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7. Date of name change:

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8. Nationality:

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9. Passport number:

Attach a certified copy of passport

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10. Place of birth:

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11. Residential telephone number:

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12. Email address:

13. Residential address:

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Notes

Attach documentary evidence of address, i.e. confirmation from an electoral register, tenancy agreement, utility bill or local tax bill

14. Dates resident at this address:

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From:

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To:

15. Previous address if less than three years at the address given in 3.13 above:

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4. DETAILS OF THE PROPOSED BUSINESS AND ACTIVITIES

Activities for which a Temporary Permit is being sought

1. Please describe the specific activities which the Applicant Firm, through the individuals identified in Section 3, intend to conduct under the terms of the Temporary Permit.

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2. Proposed date of commencement of Temporary Activities:

3. If the Applicant Firm is a branch or Subsidiary please provide the address of head office:

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5. FITNESS AND PROPRIETY QUESTIONNAIRE

This section must be completed and signed by the individuals who will perform the activities identified in Section 4.1. Please photocopy this section and attach additional copies to this Application Form as required.

Please answer ALL of the following questions:

Unless otherwise stated, the questions refer to the individual’s experience in Qatar and any other country or jurisdiction. If the individual answers YES to any question below, please provide details in the space provided.

| |Yes |No |

|Has the individual ever been convicted or found guilty of any offence related to fraud, theft, false accounting, | | |

|serious tax offences, dishonesty, money laundering, market manipulation, insider dealing or any other financial | | |

|sector crimes? | | |

|Has the individual ever been refused entry to, been dismissed from, or requested to resign from any profession, | | |

|vocation, office or employment, position of trust or fiduciary office whether or not remunerated? | | |

|Has the individual ever been refused, restricted in, or had suspended, the right to carry on any business, trade | | |

|or profession for which specific licence, registration, authorisation or other authority is required? | | |

|Has the individual ever been disqualified by a court or regulator of competent jurisdiction from acting as a | | |

|Director or in any other management capacity of any Company, Partnership or other legal entity? | | |

|Has the individual ever been censured, criticised, suspended, expelled, fined or been the subject of any | | |

|investigation, intervention or disciplinary proceedings by any Overseas Regulator, governmental authority or | | |

|other regulatory or self-regulatory authority or equivalent body? | | |

|Has the individual ever resigned or been required to resign from any Company, Partnership or other legal entity | | |

|whilst under investigation by any such body? | | |

|Has a Company, Partnership or other legal entity in any country or jurisdiction ever been wound up, put into | | |

|liquidation, ceased trading, placed in receivership or administration or negotiated a settlement with its | | |

|creditors while the individual was a Director, partner or otherwise involved in the management of that entity or | | |

|within one year of that association ending? | | |

|Has the individual ever been subject to any adverse finding by a court of competent jurisdiction for fraud, | | |

|misconduct, wrongful trading or other misconduct? | | |

|Has the individual been involved in the management of a Company, Partnership or other legal entity which has been| | |

|the subject of an investigation for malpractice or misconduct? | | |

|Has the individual ever been the subject of disciplinary procedures by a government body, agency or other self | | |

|regulatory body or professional organisation? | | |

|Has the individual ever been the subject of a formal complaint in connection with Permitted Activities which | | |

|relates to his/her integrity, competence or financial soundness? | | |

|Has the individual ever contravened any provision of financial services legislation, rule, code of practice or | | |

|principle or other standards made by or under any Overseas Regulator or similar such body? | | |

Additional information

If the individual has answered YES to any of the questions above, please provide details in the space below. If further space is required, please attach additional pages as necessary.

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I certify that the information given in this Fitness and Propriety Questionnaire is true, accurate and complete to the best of my knowledge and belief. I understand that it is a contravention of QFC Law to knowingly or recklessly provide to the QFC Authority or the QFC Regulatory Authority 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 QFC Authority or the QFC Regulatory Authority.

The QFC Regulatory Authority reserves the right to inspect records or contact me in order to ascertain further information in support of this application. I agree to waive my privacy rights so that the QFC Regulatory Authority may obtain any information necessary to assess my application.

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Print Name of Individual

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Signature

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Position

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Date

6. DECLARATION

I confirm that I have the authority to make this application, to declare as specified below and sign this Form for, or on behalf of, the Applicant Firm. I also confirm that I have the authority to give the consent specified below.

I declare that the information given in this Form and any attachments hereto is complete and accurate to the best of my knowledge and belief, having taken all reasonable steps to ensure that this is the case. I understand that it is a contravention of QFC Law to knowingly or recklessly provide to the QFC Authority or QFC Regulatory Authority 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 QFC Authority or QFC Regulatory Authority.

If at any time between the making of this application and the granting of a Temporary Permit, I become aware of a material change which is reasonably likely to be relevant to the QFC Authority or QFC Regulatory Authority, I will inform the QFC Regulatory Authority in writing of such a change without delay.

I declare my understanding that the issuance of this Temporary Permit constitutes a temporary waiver from most of the requirements that Applicants must satisfy to become Licensed by the QFC Authority or Authorised by the QFC Regulatory Authority and undertake, on behalf of the Applicant, to comply with the terms and conditions in Appendix I and any other conditions which the QFC Authority may impose as a condition of issuing this Temporary Permit.

For the purposes of the Data Protection Regulations 2005, the Personal Data provided in this Form will be processed by the QFC Regulatory Authority, the Companies Registration Office and the QFC Authority in accordance with Article 8 of the Data Protection Regulations 2005.

I declare my understanding that the QFC Regulatory Authority may request more detailed information on any matter of relevance to this application.

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Name of Director of the Applicant Firm:

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Signature of Director:

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Position

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Date

7. LIST OF ATTACHMENTS

Supporting documentation included with this application

|Section | |Document |Included |

|2.7 | |Group structure chart | |

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|3 | |Identification of Individuals | |

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|5 | |Fitness and Propriety Questionnaire | |

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|3.9 | |Certified Copy of Passport for each individual listed in section 3 | |

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| | |Full payment of the Application fee (US$2000) | |

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APPENDIX I: TERMS AND CONDITIONS OF TEMPORARY PERMIT

1. The issuance of a Temporary Permit under this Form Q16 will permit the Applicant Firm to engage in the activities specified in Section 4 of Form Q16 as may be further modified by the QFC Authority.

2. In issuing the Temporary Permit, the QFC Authority has determined to waive on a temporary basis most of the requirements that the Applicant Firm would need to satisfy to obtain a Licence under Form Q01, ‘Application for a Licence to Conduct Non-Regulated Activities’ subject to the Applicant Firm’s compliance with the general terms and conditions below, which shall form a part of its Temporary Permit, as well as any additional conditions which may be imposed.

3. The general terms and conditions are as follows:

a. The activities specified in Section 4.1 of Form Q16 shall constitute the sole activities engaged in by Applicant Firm. If the Applicant Firm wishes to conduct any activity not already specified in 4.1, it must first obtain the express written permission of QFC Authority.

b. The activities of the individuals identified in Section 3 of Form Q16 in Qatar will be supervised by Applicant Firm and the Applicant Firm must have appropriate systems and controls in place to ensure the proper supervision and conduct of the individuals who are acting pursuant to the Temporary Permit.

c. The QFC Authority may limit the number of individuals identified in Section 3 of Form Q16 that the Applicant Firm may have in Doha, Qatar at any single point in time, and the Applicant Firm shall permit no individual other than an individual identified in Section 3 of Form Q16 to conduct the activities specified in Section 4.

d. An Applicant Firm must provide prompt notification to the QFC Regulatory Authority of all material changes to the Applicant, the individuals and the Applicant Firm’s activities in Qatar that the QFC Authority may find relevant to the continuing effectiveness of this Temporary Permit.

e. If the QFC Authority determines that the continuing effectiveness of this Temporary Permit is contrary to, or that the imposition of further conditions is necessary to ensure compliance with, the QFC Law, the QFC Authority may revoke this Temporary Permit or impose further conditions as may be necessary.

f. Under the terms of the Temporary Permit, the Applicant Firm may not open any new customer accounts during the time its Temporary Permit is in effect or in any way hold itself out as being able to conduct activities that would otherwise require licensing or authorising by the QFC Authority or QFC Regulatory Authority.

g. The Applicant Firm consents to the QFC Authority or QFC Regulatory Authority undertaking visits and inspections to its premises, to ensure that the Applicant Firm is acting in compliance with the Temporary Permit and any applicable terms and conditions and, upon request, it confirms it will provide the QFC Authority or QFC Regulatory Authority with timely and unrestricted access to its books and records.

h. The failure to comply with the requirements of this Temporary Permit and its terms and conditions may provide the basis for the denial of or the imposition of conditions on the QFC Licence or Authorisation.

i. Subject to Paragraph 3(f) above, this Temporary Permit will terminate: (i) within three months of the date of its issuance, unless it is extended in writing for a period not to exceed an additional three months by the QFC Authority (ii) upon the issuance of a Licence or Authorisation, as relevant; or (iii) upon written notification by the Applicant Firm of the termination of activities for which the Temporary Permit has been issued, whichever is earlier.

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