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1. This application form shall be used for the purpose of submitting an application to issue electronic money (e-money) as a designated payment instrument under Section 11 of the Financial Services Act 2013 (FSA) or the Islamic Financial Services Act 2013 (IFSA). An applicant shall submit a cover letter, the completed application form and appendices (with clear labelling) to:

Pengarah

Jabatan Pemantauan Perkhidmatan Pembayaran

Bank Negara Malaysia

Jalan Dato’ Onn

50480 Kuala Lumpur

2. This application form consists of six (6) parts as follows:

Part 1: Background, credibility and capability

Part 2: Financial resources

Part 3: Product description

Part 4: System and security

Part 5: Risk management

Part 6: Others

3. The processing of an application shall involve the following steps:

Step 1:

Step 2:

Step 3:

Step 4:

Step 5:

|REMINDER |

|This application form must be read together with the relevant provisions in the FSA or IFSA, Guideline on Electronic Money (E-money), Anti-Money |

|Laundering, Countering Financing of Terrorism and Targeted Financial Sanctions for Financial Institutions (AML/CFT and TFS for FIs) and any other |

|relevant regulations or requirements issued by BNM. |

|Proper assessment must be made on whether the business model fulfills the definition of e-money, before any submission and payment of fee is made to BNM.|

|Please ensure that the information provided is complete, valid and contain adequate level of clarity to facilitate processing. Please label supporting |

|documents or appendices clearly to facilitate our assessment. |

|Processing of applications will only commence once the information and documentations submitted is complete, INCLUDING any subsequent additional |

|clarification or information required from the applicant by BNM. |

|BNM reserves the right to require additional information or document that is not included in the application form. |

|Applications with incomplete or unclear information and documents will be RETURNED to the applicant. |

|A cooling off period of three (3) months shall be observed for a closed/ returned application, while a cooling off period of at least six (6) months |

|shall be observed for a rejected application before the applicant is allowed to resubmit the application. BNM reserves the right to impose a longer |

|cooling off period on a case-by-case basis. |

|Please do not alter/amend any words or sentences provided by BNM in the form. |

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|Part 1: Background, credibility and capability |

|Not applicable for applicants which are financial institutions regulated by BNM |

|(a) |Applicant’s particulars |

|Name of company | |Telephone no. | |

|Company registration no. | |Fax no. | |

|Date of incorporation | |Month/Year of commencement of | |

| | |business operations | |

|Place of Incorporation | | | |

|Business address | |

|Contact person |Name: |

| |Telephone number: |

| |E-mail address: |

| |Designation: |

|Company’s business activities and | |

|products / services offered | |

|Including Group’s business | |

|activities if company is part of | |

|Group of companies | |

|Documents to be enclosed: |

|Please tick (X) and provide the required documents in accordance to the Appendix reference below. |

| |

|Appendix A : Certified true copy of company’s registration form[1] or memorandum and articles of association or other constituent documents[2] under |

|which it is established (whichever applicable) |

| |

|Appendix B : Certified true copy of certificate of incorporation or business registration |

| |

|Appendix C : Certified true copy of latest audited financial statements or, in the case of a new company which has yet to complete its first financial |

|year cycle, please provide the following: |

| |

|Appendix C1 : Return on allotment of shares under the Companies Act 2016 (if applicable); |

| |

|Appendix C2 : Latest bank statement; and |

| |

|Appendix C3 : Latest unaudited management account. |

| |

| |

|Appendix D : Statutory declaration declared before an authority, e.g. Commissioner of Oath as per the Statutory Declaration Act 1960 from the applicant |

|stating that it has not been subjected to any regulatory action, criminal convictions, records or dishonesty, fraud or violence, or breaches of statutory|

|or other administrative or regulatory enactments (refer to attached template in Appendix 1) |

| |

|Appendix E : Undertaking by the applicant to keep BNM informed of any material adverse developments affecting its financial soundness and/or reputation. |

| |

|Appendix F : Certified true copy of Board resolution or resolution of the highest decision making body of the applicant approving the application to |

|issue electronic money |

| |

|Appendix G : Details of any approval, authorisation, licence or permit required by or obtained from any regulatory authority, including a certified true |

|copy of such approval, authorisation, licence or permit (if applicable) |

| |

| |

| |

| |

|(b) |Details of shareholders |

| |If space provided is insufficient, please provide in a separate sheet |

|Name |NRIC/ passport/ BRIC[3] |Nationality |Home address |Amount of |% of shareholding |

|(Individual or company) |number | | |shareholding (RM) | |

|2. | | | | | |

|3. | | | | | |

|4. | | | | | |

|5. | | | | | |

|Total |100% |

|Documents to be enclosed: |

|Please tick (X) and provide the required documents in accordance to the Appendix reference below. |

|For individual shareholder (for foreign individuals, please provide the equivalent insolvency and credit report from home country): |

|Appendix H1 : Insolvency report from Malaysia Department of Insolvency and; |

| |

|Appendix H2 : CCRIS report |

|For company shareholder: |

|Appendix I1 : Certified true copy of company registration form issued by Companies Commission of Malaysia (if applicable) |

| |

|Appendix I2 : Certified true copy of company’s memorandum and association (if applicable) |

|(c) |Corporate structure (applicable if applicant is part of group of companies) |

|Document to be enclosed: |

|Please tick (X) and provide the required documents in accordance to the Appendix reference below. |

| |

|Appendix J : Corporate group structure (in a diagram), with adequate details of the parent company, subsidiaries and related companies, including |

|ownership structure and percentage of shareholding (please provide soft copy of this Appendix) |

|(d) |Details of Board of Directors (Board), Chief Executive Officer (CEO) and its committees |

| |If space provided is insufficient, please provide in separate sheet |

|Name |Type of directorship |Involved in day-to-day |

| |(e.g. non-executive/executive, |activities of the company (Yes |

| |independent/non-independent) |/ No) |

|1. | | |

|2. | | |

|3. | | |

|4. | | |

|5. | | |

|(e) |Organisational structure of the company |

|Document to be enclosed: |

|Please tick (X) and provide the required documents in accordance to the Appendix reference below. |

|Appendix K : Current organisational chart, showing Board of Directors, CEO, departments (including the Heads of Departments) and control functions (i.e. |

|internal audit, compliance and risk management) with reporting lines, as well as, staff headcount (including number of vacant positions, if such |

|positions are not yet filled-up) (please provide soft copy of this Appendix) |

| |

|Appendix L : Plans and timeline to fill in the key positions which are vacant stated under Appendix K above (if applicable) |

| |

| |

|Part 1A: Form to be completed by Director, CEO and senior management[4] |

|Please make copies of Part 1A and fill up specifically for each individual |

| |

|Reminder: The applicant shall ensure that its Directors, CEO and senior management fulfill the fit and proper requirements specified by BNM and possess |

|the appropriate knowledge and experience. |

|(a) |Designation of key responsible person |

| |Please tick (X) where applicable. Tick more than one box if you hold more than one position |

| |Director |

| |Chief Executive Officer |

| |Senior management (please state designation): __________________________________ |

|(b) |Particulars |

|Name | |

|NRIC/ passport/ BRIC[5] number | |

|Nationality | |

|Home address | |

|Contact number | |

|E-mail address | |

|(c) |Working experience |

| |If space provided is insufficient, please provide in separate sheet |

|Position/ Designation |Organisation/Company |Work activity/Key projects |Duration of service |

| | | |(Year to year) |

|1. | | | |

|2. | | | |

|3. | | | |

|4. | | | |

|Do you have relevant working experience in payments related area (e.g. e-money, payment cards, merchant acquiring, payment system/gateway or remittance)?|

| |

|Yes. (Please ensure such experience is reflected in the table “Working Experience” above) |

| |

|No |

|(d) |Educational background (Highest qualification) |

|Level |Institution |Year obtained |

|1. | | |

|2. | | |

|Are you involved or have been involved (e.g. as a shareholder, director, CEO or senior management) in any other business regulated by BNM? If yes, please|

|complete the following: |

|Name of business |Business activity |Type of interest |Year |

| | |(e.g. shareholder, director, CEO, senior | |

| | |management) | |

|1. | | | |

|2. | | | |

|Documents to be enclosed: |

|Please tick (X) and provide the required documents in accordance to the Appendix reference below (for foreign individuals, please provide the equivalent |

|insolvency and credit report from home country) |

|Appendix M : Statutory declaration as per Appendix 2 |

|Appendix N : Insolvency report from Malaysia Department of Insolvency |

|Appendix O : CCRIS report |

|Part 2: Financial resources |

|Not applicable for applicants which are financial institutions regulated by BNM |

|(a) |Financial resources to fund or support the business |

| | |

| |Reminder: An applicant shall demonstrate its ability to maintain minimum shareholders’ funds of RM5 million for large[6] e-money scheme or |

| |RM100,000 for small[7] e-money scheme, minimally for the first 3 years of projected operations (Refer to Appendix 3 for computation of |

| |minimum shareholders’ funds) |

|Current and projected capital position |

|This is intended to assess the applicant’s ability to maintain the shareholders’ funds requirement taking into consideration projected profit/loss. |

|Does the company’s current shareholders’ funds meet the capital requirements stated above? |

|Yes. If yes, please answer (i) only. |

|No. If No, please answer (i), (ii) and (iii) below. |

|What is the current amount of the company’s shareholders’ funds? |RM |

|Share capital (ordinary shares only) | |

|(+) Reserves - including share premium and general reserve fund | |

|(+) Retained Profit or (-) Accumulated Losses | |

|(+) Profit for the period or (-) Loss for the period | |

|(-) Intangible assets | |

|(=) Shareholders’ Funds | |

|Please provide the source and amount of additional capital to be|Source of capital |Amount (RM) |When can the additional capital be |

|injected in order to fulfil the capital requirements | | |obtained? |

|Note: If the source of capital is provided by an individual, | | | |

|only capital in the form of liquid assets are acceptable, e.g. | | | |

|balances in bank account | | | |

| |1. | | |

| |2. | | |

| |3. | | |

|Please provide evidence of capital provider’s financial capability to provide additional capital to ensure sufficient shareholders’ funds |

| |

|Documents to be enclosed as evidence: |

|Please tick (X) and provide the required documents in accordance to the Appendix reference below. |

|For individual: |

|Appendix P1 : Bank statement showing adequate balances to support the proposed additional capital |

|Appendix P2 : Letter of commitment (indicating the amount) to provide the capital |

| |

|For company: |

|Appendix P3 : Latest audited financial statements or latest unaudited management account showing adequate cash balances or cash balances equivalents, as |

|well as, positive shareholders’ funds |

| |

|Appendix P4 : Letter of commitment (indicating the amount) to provide the capital |

|Part 3: Product description |

| |Detailed description of the proposed payment instrument |

| |If space provided is insufficient , please provide in separate sheet and provide the attachment reference |

|Name of e-money product | |

|Type of payment instrument |Please tick if offered: |

| |Prepaid card |

| |Physical Virtual Proprietary International |

| |Network:_____________ |

| | |

| |(e.g. VISA, MasterCard) |

| |E-wallet via mobile app |

| | |

| |E-wallet via online portal |

| | |

| |Others, please explain: ________________________ |

|Technology used |Please tick where applicable: |

| |EMV/contactless cards |

| | |

| |Unstructured Supplementary Service Data (USSD) |

| | |

| |Short Messaging System (SMS) |

| | |

| |Near Field Communication (NFC) |

| | |

| |Quick Response (QR) code |

| | |

| |Others, please explain: _________________________ |

|Wallet limit | |

|(i.e. maximum monetary value that can |RM:_________________________ |

|be stored in an e-money) | |

|Rationale for the requested wallet | |

|limit | |

|(if applying for large scheme, please | |

|include the rationale, e.g. business | |

|needs) | |

|(b) |Description and the process flow for the following items (i) to (ii), including the security controls applicable for each item (e.g. |

| |multifactor authentications such as one-time password-OTP), for each of the functions and services below |

|Functions |Please tick (X) and provide the required documents for ALL the functions below |

|Documents to be enclosed for ALL the |App download / access to portal |

|functions: | |

|Front-end process flow (e.g. diagram/ |Registration and due diligence for: |

|screenshot); and |Users Merchants Reload agents |

|Back-end process flow. | |

| |Reload via: (including turnaround time) |

| |Cash Internet banking Debit card |

| | |

| |Credit card Others, please explain:____________ |

| | |

| |Refund via: (including turnaround time) |

| |Cash Internet banking Debit card |

| | |

| |Credit card Others, please explain:____________ |

| | |

| |Account closure (including turnaround time) |

| | |

| |Dispute resolution (including turnaround time) |

| | |

| |Settlement arrangement with all relevant parties (including turnaround time) |

| |Any other functions involved |

|(ii) Services |Please tick (X) and provide the required documents for EACH OF THE APPLICABLE services below |

|Documents to be enclosed for EACH OF |Purchase |

|THE APPLICABLE services: |Physical merchant Online In-app |

|Front-end process flow (e.g. diagram/ |Details:__________ Details:__________ Details:__________ |

|screenshot); and |(e.g. face-to-face transaction) (e.g. e-commerce, games credit) (e.g. |

|Back-end process flow. |airtime reload) |

| | |

| |Funds transfer |

| |To other e-money account (peer-to-peer/ P2P funds transfer) |

| |To own bank account |

| |Others, please explain:____________ |

| |Withdrawal |

| |Cash Bank account Others |

| |Details:_________ |

| | |

| |Cross-border remittance |

| | |

| |Any other services available |

|(c) |Value proposition and target market |

| |(Reasons why the applicant believes the proposal will be feasible and business will be viable) |

| |If space provided is insufficient , please provide in separate sheet and provide the attachment reference |

|Description of the target market |Users: _________ |

| |(e.g. students, corporates) |

| | |

| |Merchants: ________ |

| |(e.g. online, e-hailing) |

| | |

| |Locations: ________ |

| |(e.g. Klang Valley, East Malaysia, outside Malaysia) |

| | |

| |Others (if any): ________ |

|Size of target market (for the 1st year|Estimated number of users : _____ |

|of e-money operations) |Estimated number of merchants: _____ |

|Evidence of demand from the potential |Document to be enclosed as evidence: |

|user/ merchant base that have been |Please tick (X) and provide the required documents below |

|identified as the target market | |

| |Appendix Q : Letter of interest, MoU or survey response from at least 100 users or 10 merchants in the target |

| |market (for small e-money scheme) or 500 users or 20 merchants (for large e-money scheme). For this purpose, |

| |users can also be represented by the organization of which the users are connected to (e.g. an MoU from a single |

| |university may represent all the students in the university as potential users of the product) |

|Describe the benefits/additional value | |

|of the product to the target market | |

|(e.g. Target market yet to have any | |

|access to e-money/underserved segments,| |

|environmental/sustainable activities, | |

|etc.) | |

|(d) |For application to issue a designated Islamic payment instrument pursuant to section 9 of the IFSA (if applicable) |

|Document to be enclosed: |

|Please tick (X) and provide the required documents below. |

| |

|Appendix R : Attestation from a qualified Shariah advisor[8] on the Shariah aspects of the payment instrument including application of Shariah contracts |

|and operational arrangement of the payment mechanism of the payment instrument to ensure compliance with Shariah. |

|Part 4: System and security |

|Reminder: The applicant shall demonstrate that it has the capability to ensure a robust system and security measures and infrastructure are in place |

|for the proposed product. |

|Overview of system and security |

|Overview of network and security architecture |Document to be enclosed: |

|(including placements of relevant servers and |Appendix S : DIAGRAMMATIC ILLUSTRATION with adequate description of the network architecture of |

|security devices within the network zones e.g. |items below. The diagram includes the following (please tick (X) where applicable): |

|untrusted zone, demilitarized zone (DMZ) and | |

|secured zone) |End-to-end communication |

| | |

|For end-to-end communications including |Data centres (production and recovery) |

|connectivity between endpoint, data centre and | |

|host system and third party integrations |Servers |

| | |

| |Firewalls |

| | |

| |Intrusion prevention system (IPS) |

| | |

| |Other devices |

| |Details: ___________________________________________________ |

|Details of data/network/communications encryption|Data encryption (including the encryption type, version and strength) |

|standards used |Details: ___________________________________________________ |

|For end-to-end communications including | |

|connectivity between endpoint, data center and |Network encryption (including the encryption type, version and strength) |

|host system and thirdparty integrations |Details: ___________________________________________________ |

| | |

| |Communication session encryption (including the encryption type, version and strength) |

| |Details: ___________________________________________________ |

| | |

| |Hashing algorithms (including the encryption type, version and strength) |

| |Details: ___________________________________________________ |

| | |

| |Others |

| |Details: ___________________________________________________ |

|Methods used for prevention and detection of | |

|fraud/scam |Image verification upon log-in |

|(Example of fraud: card/device theft, account |Details: ___________________________________________________ |

|takeover, card clone) | |

|(Example of scam: phishing) |Word/ number verification method upon log-in |

| |Details: ___________________________________________________ |

| | |

| |Awareness programs: |

| | |

| |On website |

| |Details: ___________________________________________________ |

| | |

| |Brochures |

| |Details: ___________________________________________________ |

| | |

| |At partners’ premise |

| |Details: ___________________________________________________ |

| | |

| |Others |

| |Details: ___________________________________________________ |

| | |

| |Call back customer checks |

| |Details: ___________________________________________________ |

| | |

| |SMS alert/ notification on suspicious activities e.g. login and transactions |

| |Details: ___________________________________________________ |

| | |

| |Detection system and methods used to monitor e-money transaction anomalies: |

| | |

| |Real-time monitoring |

| |Details: ___________________________________________________ |

| | |

| |Daily monitoring |

| |Details: ___________________________________________________ |

| | |

| |Others |

| |Details: ___________________________________________________ |

| | |

| |Establish transaction limit |

| | |

| |Daily cumulative |

| |Amount: ___________________________________________________ |

| | |

| |Transaction |

| |Amount: ___________________________________________________ |

| | |

| |Others |

| |Amount: ___________________________________________________ |

|Security devices/methods used for protection | |

|against cyber threats |Yes. This includes: |

| |Firewall (2 tiers) |

| |Details (including type and name): |

| |___________________________________________________ |

| | |

| |Anti-virus |

| |Details (including type and name): |

| |___________________________________________________ |

| | |

| |System session communication security |

| |Details (including type and name): |

| |___________________________________________________ |

| | |

| |DDoS protection |

| |Details (including type and name): |

| |___________________________________________________ |

| | |

| |Spam protection |

| |Details (including type and name): |

| |___________________________________________________ |

| | |

| |Malware protection |

| |Details (including type and name): |

| |___________________________________________________ |

| | |

| |Security monitoring via security incident event management (SIEM) |

| |Details (including type and name): |

| |___________________________________________________ |

| | |

| |Others |

| |Details: |

| |___________________________________________________ |

|Network and application vulnerability assessment | |

|and penetration testing |Yes. Please provide copy of report |

| |Details (including testing cycle): |

| |________________________________________________________ |

| | |

| | |

| | |

| |None. Please provide plan. |

| |Details: _________________________________________________ |

|IT certification | |

| |Yes. Please provide copy of certification report |

| |Type of certification: ______________________________________ |

| | |

| |Purpose of certification: ___________________________________ |

| | |

| | |

| |None. |

|Documents to be enclosed: |

|Please tick (X) and provide the required documents in accordance to the Appendix reference below. |

| |

|Appendix T1 : Network and application vulnerability assessment/ penetration testing report of the solution including rectification of issued raised |

|Appendix T2 : DIAGRAMMATIC ILLUSTRATION with adequate description of the network segment/security zone (logical grouping of the systems in the |

|network and its security implementation) |

|Appendix T3 : Certification obtained, e.g. Information Security Management System (ISMS) certification |

|Describe the security measures deployed on user’s mobile app/ mobile device and merchant’s endpoint devices (if applicable) to mitigate cyber |

|threats: |

|Types of mobile phone operating systems allowed | |

|for installation of wallet app and facilitation |Android |

|of transactions (e.g. Android, IOS, etc.) |Version: ____________________________________________ |

| | |

| |IOS |

| |Version: ____________________________________________ |

| | |

| |Others |

| |Version: ____________________________________________ |

|Methods used for binding of customer’s or | |

|merchant’s app to the endpoint device |Yes. The mobile app is tied with a unique device ID using: |

| | |

| |International Mobile Equipment Identity (IMEI) |

| |Details: ____________________________________________ |

| | |

| |Digital certificate |

| |Details: ____________________________________________ |

| | |

| |Others |

| |Details: ____________________________________________ |

| | |

| | |

| |None. |

|Methods used for protecting e-wallet from being | |

|used on unsecured phone and outdated versions |Yes |

| |Details: ___________________________________________ |

| | |

| |None. |

|Multi-factor authentication deployed | |

| |Yes. |

| |Describe the type of authentication used: |

| | |

| |What you know |

| |Details: (e.g. password, PIN code) ______________________________________________________ |

| | |

| |What you have |

| |Details (e.g. SMS TAC/One-Time Password) : ______________________________________________________ |

| | |

| |Who you are |

| |Details (e.g. biometrics) : ______________________________________________________ |

| | |

| |Others: |

| |Details: ________________________________________________ |

| | |

| | |

| |None. |

|Notifications deployed to facilitate transactions| |

| |Yes. Using: |

|(eg. notification for every successful | |

|transactions) |SMS |

| |Details: ____________________________________________ |

| | |

| |Email |

| |Details: ____________________________________________ |

| | |

| |Other |

| |Details: ____________________________________________ |

| | |

| |None. |

|Methods to prevent usage of app on jail-broken or| |

|rooted end-point devices |Yes |

| |Details: ___________________________________________ |

| | |

| |None. |

|Method for installation of e-wallet app on | |

|customer/ merchant devices |Yes |

| |Details: ___________________________________________ |

| | |

| |None. |

|Methods to prevent fake or counterfeit app | |

|existing in Google or Apple stores |Yes |

| |Details: ___________________________________________ |

| | |

| |None. |

|Enforcement of geo-location tracking for all | |

|registrations and transactions |Yes |

| |Details: ___________________________________________ |

| | |

| |None. |

|Restriction of fund transfers, i.e. to allow | |

|transfers to be conducted within Malaysia (if |Yes |

|funds transfer service is provided) |Details: ___________________________________________ |

| | |

| |None. |

|Details of POS terminal security configuration | |

|for protection against cyber threats (e.g. | |

|malware attacks) | |

|Details of network encryption for communication | |

|between the merchant, POS service provider and | |

|the institution’s host server (including the | |

|encryption type, version and strength) | |

|Describe the security measures deployed for products that involve QR codes (if applicable): |

|Description of the type of QR code used | |

| |Static |

| |Details: ____________________________________________ |

| | |

| |Dynamic |

| |Details: ____________________________________________ |

| |Validity: ____________________________________________ |

| | |

| |Others |

| |Details: ____________________________________________ |

|Security details of QR code |Code contents: |

| |______________________________________________________ |

| | |

| |Encryption (type version and strength): |

| |______________________________________________________ |

| | |

| |Code generation process (including token): |

| |______________________________________________________ |

| | |

| |Code usage: |

| |______________________________________________________ |

| | |

| |Code storage: |

| |______________________________________________________ |

| | |

| |Other security details: |

| |______________________________________________________ |

|Methods for detecting and blocking usage of | |

|illegitimate QR codes |Yes. |

| |Details: _________________________________________________ |

| | |

| |None. |

|Part 5: Risk management |

|If space provided is insufficient, please provide in separate sheet and provide the attachment reference |

|(a) |Internal audit function |

| |Current |Proposed |

| | |(if vacant during application stage) |

|For in house function |

|Name of department | | |

|Name of officer | | |

|Qualification | | |

|Experience | | |

|If outsourced or involve internal audit of group |

|Name of outsourced party/ function in the| | |

|group | | |

|Background info | | |

|(e.g. track record, type of assurance | | |

|services provided) | | |

|(b) |Compliance function |

| |Current |Proposed |

| | |(if vacant during application stage) |

|Name | | |

|Qualification | | |

|Experience | | |

|(c) |Risk management function |

| |Current |Proposed |

| | |(if vacant during application stage) |

|Name | | |

|Qualification | | |

|Experience | | |

| |

|(d) |Risk management, internal control, as well as, policies and procedures |

| |Reminder: The applicant shall demonstrate understanding of the risks involved in the proposed e-money business and shall identify adequate|

| |risk mitigation measures to manage such risks. |

|Summary of assessment on major risk areas: |

|If space provided is insufficient, please provide in a separate sheet and provide the attachment reference |

|Type of risk |Level of risk |Description of the potential risk involved with|Risk mitigation measures |

| |(High, Medium, Low) |regards to the proposed e-money business |(for high/ medium risk) |

|Operational | |e.g. inadequate/ failed internal processes or | |

| | |human error | |

|ML/TF | |e.g. inability to verify customer information | |

| | |due to current system/ resource/operational | |

| | |limitations | |

|Security/ Technology | |e.g. product may be vulnerable to cyber-attack,| |

| | |system hacking or disruption due to current | |

| | |limitation of system/architecture | |

|Fraud/Scam | |e.g. vulnerability of product to fraud or scam | |

| | |due to limitations in current | |

| | |infrastructure/operational procedures | |

|Others (e.g. Legal, | | | |

|Outsourcing, Market risk) | | | |

|Measures for the management of funds collected | |Current |Proposed |

|from users (do not include own working capital) | | | |

|[Refer to Principle 4 of the Guideline on | | | |

|E-Money] | | | |

| |Trust account (for large scheme) |

| |Name of trustee | | |

| |Name of bank | | |

| |Dedicated deposit account (for small scheme) |

| |Name of bank | | |

| |Others, to explain | | |

|Measures for business continuity and plan for |Please describe key measures for business continuity planning: |

|disaster recovery of the system | |

| |____________________________________________________ |

| | |

| |Location of production site: ______________ |

| |Location of alternative site: ______________ |

|Measures for the management of AML/CFT risks |

|If space provided is insufficient, please provide in a separate sheet |

| |

|[Refer to Anti-Money Laundering, Countering Financing of Terrorism and Targeted Financial Sanctions for Financial Institutions (AML/CFT and TFS for FIs)]|

|(e) |Outsourcing arrangement (if applicable) |

|Description of any outsourcing arrangement | |Current |Proposed |

| | | |(for potential areas/ functions) |

| |Name of outsourced party | | |

| |Areas/ functions | | |

| |outsourced | | |

| |Roles and responsibilities| | |

| |of the outsourced party | | |

|Part 6: Others |

|Processing fee |

|An applicant is required to pay a fee of RM500 to BNM via the following channel: |Documents to be enclosed: |

|RENTAS with TRN code OBT01, account number 1547010015; or |Please tick (X) and provide the required documents |

|Internet banking to Maybank account number of 514150127067 under the name of Bank Negara | |

|Malaysia. |Appendix U : Receipt or proof of payment for processing fee.|

|Such fees shall be paid by the applicant not later than seven (7) working days from the date| |

|the application is submitted to BNM. | |

|Attestation by applicant |

|We hereby certify to the best of our knowledge that the information provided are true and |Name of Authorized Representative |

|correct, that all available information and data have been supplied herein, and that we |(Chief Executive Officer): |

|agree to show documentary proof and additional information thereof upon BNM’s request. | |

| |__________________________________ |

| | |

| |Signature:__________________________ |

| | |

| |Date:______________________ |

Appendix 1

Statutory Declaration from the Applicant

I, ......................................... (name), of *NRIC / *Passport No. ........................ the ................................(state the position) of ................................(“Applicant”) do solemnly and sincerely declare that:

A. The applicant has not been the subject of any regulatory actions, criminal convictions, records of dishonesty, fraud, or violence or breaches of statutory or other administrative or regulatory enactments; and

B. The applicant has submitted an application for approval from Bank Negara Malaysia under Section 11 of the Financial Services Act 2013 or Islamic Financial Services Act 2013. The applicant understands that if the applicant furnishes any information required which is false, inaccurate, misleading or contains material errors or omissions, the approval may not be granted by Bank Negara Malaysia. In the event that the approval has been granted, it may be revoked.

And I make this solemn declaration conscientiously believing the same to be true, and by virtue of the provisions of the Statutory Declarations Act 1960.

Subscribed and solemnly declared by the abovenamed .......................................) at..............................) in the State of......................) this.......................20..............)

Before me:

.......................................................

(Signature of Sessions Court Judge, Magistrate or Commissioner of Oaths)

Appendix 2

Statutory Declaration from the Directors, CEO and Senior Management[11]

I, .................................................................... (name), of *NRIC / *Passport No. ............................. the ............................... (state the position) of .................................... (“Applicant”) since ........................ (date) do solemnly and sincerely declare that:

A. I am not subject to the disqualifications mentioned below:

i) I have not been the subject of any regulatory actions, criminal convictions, records of dishonesty, fraud or violence or breaches of statutory or other administrative or regulatory enactments;

ii) I have not been involved as a senior officer or a member of the senior management of any company which has been the subject of any regulatory actions, criminal convictions, records of dishonesty, fraud or violence or breaches of statutory or other administrative or regulatory enactments; and

B. The applicant has submitted an application for approval from Bank Negara Malaysia under section 11 of the Financial Services Act 2013. I understand that if I furnish any information required which is false, inaccurate, misleading or contains material errors or omissions, the approval may not be granted by Bank Negara Malaysia. In the event that the approval has been granted, it may be revoked.

And I make this solemn declaration conscientiously believing the same to be true, and by virtue of the provisions of the Statutory Declarations Act 1960.

Subscribed and solemnly declared by the abovenamed ..................................) at...........................) in the State of.........................) this..................20..............)

Before me:

..........................................................

(Signature of Sessions Court Judge, Magistrate or Commissioner of Oaths)

Appendix 3

Computation of shareholders’ funds

Share capital which includes:

▪ Paid-up ordinary shares/common stock

plus Reserves which includes:

▪ Share premium

▪ General reserve fund

plus Retained Profit (or less Accumulated Losses)

plus Audited Profit for the period (or less Unaudited Loss for the period)

less Intangible Assets[12]

[pic]

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[1] Under Companies Act 2016.

[2] Under Companies Act 1965.

[3] Business registration or identity card number.

[4] Head of departments or equivalent and above.

[5] Business registration or identity card number.

[6] Refers to e-money scheme with:

i) purse limit exceeding RM200 (maximum limit is capped at RM1,500 or any amount as approved by BNM); or

ii) outstanding e-money liabilities for 6 consecutive months amounting to RM1 million or more.

[7] Refers to e-money scheme with:

i) purse limit not exceeding RM200; and

ii) outstanding e-money liabilities of less than RM1 million.

[8] May include individuals, companies or existing Shariah Committee endorsed by BNM.

[9] E.g. During on-boarding stage or when customer perform transaction that require CDD.

[10] E.g. Matching of customer’s photo in the ID with the selfie.

[11] Head of departments or equivalent and above.

[12] Including goodwill, capitalised development costs, licenses and intellectual properties.

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BANK NEGARA MALAYSIA

APPLICATION FORM TO ISSUE E-MONEY AS A DESIGNATED PAYMENT INSTRUMENT

Prospective applicant to e-mail to pdapplication@.my to indicate the intention to submit an application. A preliminary discussion may be arranged to ensure that the prospective applicant is aware of the requirements and application procedures. Please DO NOT submit any formal application yet.

Submission of formal application (hardcopy) to Bank Negara Malaysia (BNM). Please provide the soft copy of the application form and appendix (where stated) via email to pdapplication@.my

The applicant may be contacted by BNM officers for clarification or request for additional information. Applicants will be given a specified time period to provide the information.

If the information/clarification provided is inadequate or not provided within the specified time period, the submission will be returned to the applicant and no longer processed. Otherwise, BNM will proceed to process the application.

Applicant will be informed on the result of the application.

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