C2
C2
B
B
Local Resident
Application for consent to issue shares and / or admit a guarantor member in a proposed Jersey Company
(made pursuant to the provisions of the Control of Borrowing (Jersey) Order, 1958, as amended).
For Official
Use Only
Part A
1. Name of proposed company
A
CP Number:
2. Details of share capital or guarantee:
B
A Par Value
Currency
Authorised
capital
Number of
shares
Par value of
each share
Class / Type
Limited
Add Further Information
B No Par Value
Number of
shares
Unlimited
or unlimited
number
Class/Type
Unlimited
Limited
Add Further Information
The Companies (Jersey) Law 1991 does not allow a company to have a mix of Par Value and No Par Value
shares. For No Par Value shares choose the number of shares authorised or select the unrestricted box.
C Guarantee
Name of Guarantor
Maximum Amount Guaranteed
Currency:
Amount:
Address
Parish
Post code:
Country
Add Further Information
Personal data provided in this application will be used by the Commission - a data controller as defined in the Data
Protection Law - to discharge its statutory functions under the Control of Borrowing (Jersey) Law 1947, as amended,
and it may be disclosed to third parties for those purposes. Further information may be found in the Commission’s
data protection policy, copies of which are available on request from the Commission and which may also be found
on www.jerseyfsc.org
The Commission may seek to verify the information in this application including answers relating to fitness and propriety.
CP Number:
For Official
Use Only
Part B
3. Confirm that none of the beneficial owner(s), the Settlor or named beneficiaries has in any part of the
world been declared bankrupt or “en desastre” or been a Director of, or otherwise concerned in the
management of, a company which has been subject to an insolvent liquidation or been the subject of a
Judicial enquiry. (If such confirmation cannot be given, give full details in the box below)
C
Confirmed
D
4. State ultimate beneficial owner(s) of the proposed company.
Individual
Title (Mr / Mrs / Miss etc...)
Surname
Given Names
Date of Birth
d d
m m m
y y y y
Occupation
Place of Birth
Address
Parish
Post code:
Jersey
Country
Add Further Information
Passport details
Passport details
Passport details
CP Number:
For Official
Use Only
Part C
E
Activity
5. Please tick appropriate box. If the activity of the proposed company is not given in activity 5.1 to 5.10
please enter appropriate details in 5.11.
5.1
Holding real estate
5.2
Unregulated fund
5.3
Holding a self administered pension plan
5.4
Holding an asset (such as a car, aircraft, boat or a horse)
5.5
Conducting a local non sensitive trade
5.6
Conducting an international non sensitive trade
5.7
Consulting
5.8
Owning intellectual property rights
5.9
Investing in listed securities
5.10
Investing in unlisted companies / entities who conduct activities which do not appear on the
Commission’s sensitive activity policy
5.11
Other (Please give details below)
Confirm that the activity of the new company will not conflict with the Commission’s sensitive
activity policy.
Confirmed
5. I declare that the above particulars, and information given in any attached correspondence, are true to the best of my knowledge and belief, and that I am aware of the penalties contained in the Control of Borrowing (Jersey) Law, 1947, as amended, for providing false information.
Full Name
Signature
Dated
d d
m m m
y y y y
F
Further information
Further information
Further information
Further information