Palestine Monetary Authority

PALESTINE MONETARY AUTHORITY

Appendix No. (1)

Application for Approval of Payment Services Company License

| Date: | / / |

Applicant Information

Proposed Company Name
Legal Form of the Company
Paid-up Capital
Full Company Address
Phone Number
Mobile Number
Email Address

Required Documents and Data to Attach

1	List of founders' names, nationalities, places of residence, and curricula vitae, including qualifications, experience, and supporting documents.
2	Draft memorandum of association and internal regulations of the company, ensuring the memorandum specifies the company's objectives.
3	Written explanatory statement on the type of payment service, its objectives, a description of its operational mechanisms, support for subscribers and beneficiaries, planned distribution locations, and any other explanatory materials requested by the Authority.
4	Economic feasibility study, estimated budgets, and potential company partners for the first three years of operation, based on realistic estimates.
5	Draft strategic business plan for the company for the next five years.
6	Certificate of non-criminal record for each founder issued by the competent authorities in Palestine.
7	Description of the policies and procedures to be used
8	Written letter from the founders certifying the following: ; A- That none of the founders has been declared bankrupt or unable to pay debts without having their reputation restored. ; B- That none of the founders has been convicted by a competent court with a final judgment for crimes of theft, fraud, embezzlement, forgery, defamation, bribery, breach of trust, crimes against honor, integrity, or public morals, or any money laundering crimes. ; C- Sound credit performance, including that none of the founders has defaulted on any of their banking obligations.

We, the undersigned, members of the founding committee, certify that all information provided in this application and its attachments is complete and accurate:

Name:	Signature:	Date:
Name:	Signature:	Date:
Name:	Signature:	Date:

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www.pma.ps

Ramallah - Palestine P.O. Box 452 | Tel: +970 2 2415250 | Fax: +970 2 2415310 | Email: info@pma.ps

Gaza - Palestine P.O. Box 4026 | Tel: +970 8 2825292 | Fax: +970 8 2844487 | Email: info@pma.ps

Ramallah - Palestine PO. Box 452 | Tel: +970 2 2415250 | Fax: +970 2 2415310 | Email: info@pma.ps

Gaza - Palestine PO Box 4026 | Tel: +970 8 2825292 | Fax: +970 8 2844487 | Email: info@pma.ps