Application for Registration as a Payment Service Provider or E-Money Issuer

PSP/EMI
APPLICATION
FORM
APPLICATION FOR REGISTRATION AS A PAYMENT SERVICE PROVIDER UNDER SECTION 36(CC) OF THE CENTRAL BANK ACT CHAP. 79:02 OR AN E-MONEY ISSUER UNDER THE E-MONEY ISSUER ORDER, 2020 (AS AMENDED)
PART A - INSTRUCTIONS FOR COMPLETING THE APPLICATION
FORM
This Application Form applies to applicants seeking to be registered with the Central Bank of Trinidad and Tobago (“Central Bank”) as:
i. a Payment Service Provider (“PSP”) pursuant to section 36(cc) of the Central Bank
Act Chap. 79:02 (“CBA”) and the Payments System Guideline No. 3 - Operation of Payment Service Providers (“Guideline No. 3”); or
ii. an E-Money Issuer (“EMI”) under the E-Money Issuer Order, 2020 (as amended)
(“EMI Order”).
Applicants are required to submit the requisite information and documentation as detailed below, along with this Application Form to PSregistration@central-bank.org.tt. All information requested under this Application Form is required for the assessment of the Application and will be treated by the Central Bank in accordance with the secrecy and confidentiality obligations set out in section 56 of the CBA and section 8 of the Financial Institutions Act Chap. 79:09. Sections of the Application Form:

• Part A – Instructions for Completing the Application Form
• Part B – Applicant Details
• Part C – Business Plan
• Part D – Application Checklist
• Part E – Information to be Provided by E-Money Issuers Only
• Part F – Declaration
  A.1 APPLICATION FOR REGISTRATION AS A PAYMENT SERVICE PROVIDER Applicants desirous of registering as a PSP with the Central Bank under section 36(cc) of the CBA and Guideline No. 3, must submit the following documentation:
  (a) the accompanying application letter (refer to Appendix 1 for sample);

PSP/EMI
APPLICATION
FORM
(b) completed Parts B, C, D and F of this Application Form; and (c) all applicable supporting documents and information referred to in the Part C - Application Checklist. A.2 APPLICATION FOR REGISTRATION AS AN E-MONEY ISSUER Where an applicant (including a subsidiary of an existing PSP) is applying to be registered as an EMI pursuant to the EMI Order, the applicant will also need to be registered separately as a PSP under the CBA to provide payment service activities. Please note that the EMI Order permits the applications to be made simultaneously. The applicant must:
i. indicate, via the accompanying application letter (refer to Appendix 2 for
sample) that the Application is being made for registration as an EMI as well as a PSP;
ii. complete the Application Form in its entirety along with all supporting
documents; and
iii. submit evidence of a non-refundable application fee payable to the Central
Bank. The application fee is prescribed under the clause 5(4) and Schedule 1 of the EMI Order. A.3 FILLING IN THE APPLICATION FORM All applicants are advised of the following:
i. It is important to read the applicable legislation, policies and guidelines prior to
completing this form.
ii. The completed Application Form must be duly signed by a minimum of two (2)
directors identifying their current designation within the business.
iii. All documents/information requested by the Central Bank must be submitted in support
of the application as detailed in Part C - Application Checklist below. Please note that attachments should be provided in a searchable and comment-enabled format and must be provided in English, or with a certified English translation.
iv. All documents/information (including policies and procedures) provided in support of
the application should be tailored to your business model and not be generic templates.
v. Applications will be deemed incomplete if all required information is not received and
will result in a delay in the Central Bank’s consideration of the application.
vi. Any questions that have a YES and NO box should be ticked or completed as
appropriate.
vii. If there are any subsequent changes in the information provided in the application after
submission, the Central Bank should be notified immediately. Any relevant documentation must also be submitted at this time.

PSP/EMI
APPLICATION
FORM
viii. Applicants are advised that providing false or misleading information to the Central
Bank, in connection with this application, may result in the refusal of the application or subsequent cancellation.
ix. All applicants granted registration as a PSP or an EMI will be required to operate in
accordance with the information provided in their application, except where this information is altered with the approval of the Central Bank.
x. An applicant should not submit an application to the Central Bank where it has not
determined with reasonable certainty:
a. the scope of the activities in which it proposes to engage; and b. its proposed business and operational model.

PSP/EMI
APPLICATION
FORM
APPLICATION FOR REGISTRATION
PART B: APPLICANT DETAILS

1. CONTACT PERSON
   Please provide details of the person designated by the applicant whom the Central Bank may contact regarding this application. (a) Date of Submission:
   (b) Name of Contact Person:
   (c) Position of Contact Person:
   (d) Telephone Number:
   (e) Email Address:
2. APPLICATION HISTORY WITH THE CENTRAL BANK
   (a) Has the applicant ever applied, or held an interest in a business that has applied to Central Bank for an approval? YES ☐ NO ☐ If yes, provide information in the below starting from the most recent record. Date of Application Type of registration or licence applied for Status of Application (e.g. in progress, approved, withdrawn, rejected)
3. LEGAL AND CORPORATE GOVERNANCE ARRANGEMENTS
   (a) Registered Company Name:
   (b) Trade name (if different from above):
   (c) Registered Business Address:
   (d) Is the above registered business address same as the address of the Company’s permanent place of business or mailing address? YES☐ NO☐

PSP/EMI
APPLICATION
FORM
3. LEGAL AND CORPORATE GOVERNANCE ARRANGEMENTS
(e) If, no please indicate:
(f) Telephone Number:
(g) Email Address:
(h) Institution Website Address:
(i) As per your Articles of Incorporation, what is nature of the products and/or services you are registered to provide? (j) Additional comment (if required):
(k) Is the applicant a subsidiary of another company?
YES☐ NO☐
(l) If yes, please state which company:
(m) Country of origin of ultimate parent company:
(n) Does the applicant have ownership in other company(ies)?
YES☐ NO☐
(o) If yes, please state the name and address of subsidiary companies/associated firms/other associated companies:
(p) Is the applicant registered with the Financial Intelligence Unit of Trinidad and Tobago (FIU)? YES☐ NO☐ (q) If yes, please state type of registration and year:
(r) Financial year end of the applicant
(DD/MMM):
(s) Financial year end of the applicant’s parent company (DD/MMM) (if applicable):

PSP/EMI
APPLICATION
FORM
4. TYPE OF PAYMENT SERVICE(S) THE APPLICANT INTENDS TO PROVIDE
Please select all that apply.
☐ Provision of service functional to the transfer of money ☐ Issuing or acquisition of payment instruments ☐ Provision of services related to the acceptance, clearance and settlement of claims generated from the use of payment instruments ☐ Issuing of e-money accounts ☐ Provision of electronic wallet services ☐ Provision of remittance service
PART C: BUSINESS PLAN
5. PROPOSED BUSINESS PLAN – to be attached with the application and should include the following:
(a) The business overview, concept and the proposed scope of the activities. (b) The business strategy, market analysis, and the business and operational model to be used. (c) A description of the product and services to be offered, including fees and commissions to be charged, where applicable. (d) A description of the planned channels of delivery for the proposed products and services. (e) A description of the proposed customer base. (f) Details on the activities to be run in-house and those that shall be outsourced to a third party. (g) Details on exit strategy and/or winding down plan. (h) A description of any other regulated activities that the applicant intends to conduct. (i) The road map for implementation of the business plan.

PSP/EMI
APPLICATION
FORM
PART D: CHECKLIST OF DOCUMENTS TO BE SUBMITTED IN
SUPPORT OF APPLICATION
Applicants are advised that all documents/information requested by the Central Bank must be submitted in support of their applications.
6. INCORPORATION/ COMPANY DOCUMENTS Attached
Yes/No
Please indicate document and page number
6.1 A certified copy of the Company’s documents as filed with the
Registrar of Companies:
(a) Certificate of Incorporation and/or Continuance (b) Articles of Incorporation (c) By-laws (d) Annual Return (most recent) (e) Notice of Directors / Notice of Change in Directors (f) Notice of Secretary / Notice of Change in Secretary (g) Notice of Address/ Notice of Address of Registered Office (h) Return on Beneficial Interest in the Shares of a Company or any other constituent document, including any amendments. 7 GOVERNANCE ARRANGEMENT/ GROUP AND ORGANIZATIONAL STRUCTRE Attached Yes/No Please indicate document and page number
7.1 In accordance with the Corporate Governance Guideline, a
detailed Organisational Chart of the applicant outlining and identifying:

• Members of the Board of Directors*
• Senior Management
  *For EMIs, at least two (2) persons one (1) of whom must possess the requisite experience and technical knowledge to direct the business activities of the EMI.
  7.2 Completed Personal Questionnaire and Declaration (PQD) forms
  for Shareholders, Directors and each named Officer referenced on the Organisational Chart, accompanied by supporting documentation (in original or certified form) including the following in accordance with the Fit and Proper Guideline – October 2019:
• Certificate of Character from the Police Services of
  Trinidad and Tobago or Overseas Law Enforcement Clearance Report dated within six (6) months of this application;
• Certified (or notarized, as applicable) coloured copy of a
  valid Photo Identification (National Identification card, Driver’s Permit or Passport); and
• Up-to-date Curriculum Vitae or Resume (signed by the
  individual).

PSP/EMI
APPLICATION
FORM
7 GOVERNANCE ARRANGEMENT/
GROUP AND ORGANIZATIONAL STRUCTRE
Attached
Yes/No
Please indicate document and page number
7.3 Corporate Controller’s information on acquirers, significant and
controlling shareholders, directors and senior management of the applicant, inclusive of a Group Chart showing all the applicants in the group that are either owned or controlled by the Applicant’s acquirer, controlling and significant shareholder, highlighting the percentage of ownership.
7.4 Completed Corporate Questionnaire and Declaration (CQD) form
for the applicant accompanied by supporting documentation (in original or certified form).
7.5 An applicant from an overseas jurisdiction seeking to establish a
subsidiary in Trinidad and Tobago, should provide the following information:
(a) Incorporation documents
(b) Head Office Name
(c) Head Office Address
(d) Country of Incorporation
(e) The Regulator in country of incorporation (if applicable) -
i. Name
ii. Address
iii. Certified copy of license to operate
iv. Letter of no objection from the Regulator
(f) List of all countries the applicant operates from including the details of respective Regulators 8 FINANCIAL OPERATIONS Attached Yes/No Please indicate document and page number
8.1 a. Copies of Audited Financial Statements (Balance Sheet, Income
Statement and Cash Flow Statement) - for the last three (3) years (where applicable); b. Projected financial statements (Balance Sheet, Income and Cash Flow Statements) for the first three (3) years of operations; and
c. Management accounts for the operating period, no more than
three (3) months prior to the submission of the Application.
9. CAPITAL AND RESERVES:
(a) Issued share capital TT$
(b) Paid-up share capital TT$
(c) Capital reserves TT$
(d) Retained earnings TT$
(e) Other TT$

PSP/EMI
APPLICATION
FORM
10. SOURCE OF FUNDS
(a) Please provide information and documentary evidence.
Evidence should be reflected in a bank statement of a licensed bank or a deposit-taking institution under the Financial Institutions Act Chap 79:07 Source of Funds Name of institution/ individual Amount received (or to be received) (TT$) Examples may include: Applicant, Loan from financial institutions, Loan/Investment from family or friends, Angel Investor/Venture Capital, Crowdfunding, Initial Public Offering, Initial Coin Offering, Grant or government incentive, Others (Please specify) 11 RISK MANAGEMENT Attached Yes/No Please indicate document and page number
11.1 Risk Management policies and/or frameworks (in accordance
with the Central Bank’s Guidelines) inclusive of:
(a) Enterprise Risk Management:
i. Information and Communications Technology Risk
Management
ii. Business Continuity
iii. Cyber Resilience (based on the Central Bank’s
Cybersecurity Best Practice Guideline)
iv. Cyber Risk
v. Operational Resilience and Risk Management
(b) Liquidity Risk Management
(c) Internal Controls
(d) Anti-Money Laundering and Combatting Terrorist Financing (AML/CTF) (to be prepared also in compliance with the Financial Intelligence Unit of Trinidad and Tobago’s regulations and guidelines.) 12 INFORMATION AND COMMUNICATION TECHNOLOGY (ICT) Attached Yes/No Please indicate document and page number
12.1 Information and Communications Technology. (Please send an
email to PSregistration@central-bank.org.tt to request the Information and Communications Technology Request Form.)

PSP/EMI
APPLICATION
FORM
13 OUTSOURCING / THIRD PARTY SERVICES
ARRANGEMENTS
Attached
Yes/No
Please indicate document and page number
13.1 Board approved Outsourcing Policy and Procedures that guides
the development and approval process for the outsourcing of material activities. The Outsourcing Policy must align with the principles set out in the Central Bank’s Guideline for the management of Outsourcing Risk.
13.2 Details of services outsourced to related companies within the
Applicant’s Group Structure, where applicable.
13.3 List of all its outsourcing contracts, which also identifies the
material outsourced services.
13.4 Copies of Executed or Draft Agreements and Terms of Use for
each outsourced activity/applicant (partners, providers).
14 AGENT AND AGENT MANAGEMENT Attached
Yes/No
Please indicate document and page number
14.1 A list of all agents used, and information relevant to these agents
including name, address, GPS coordinates, telephone contact (including the contacts and addresses for each outlet of the agent at which it will provide services on behalf of the registrant). 15 SETTLEMENT ARRANGEMENTS Attached Yes/No Please indicate document and page number
15.1 Settlement procedures accompanied by:
(a) details on the management of settlement risk; (b) a detailed diagram on the applicant’s settlement process of showing the flow of funds between the customers, agents, and settlement agent(s); and (c) information on the applicant’s settlement times. 16 MARKET CONDUCT Attached Yes/No Please indicate document and page number
16.1 Consumer Protection and Disclosure Policy (in accordance
with the Central Bank’s Market Conduct Guideline) addressing:
(a) Terms of Use/ Terms and Conditions that will apply to the applicant’s customers, agents and merchants; (b) User Service Agreements; (c) Privacy Rules/Policy; (d) Charges and/or fees associated with the service; (e) Information that will facilitate participants’ understanding of the service rules and procedures; (f) The risks that users/clients will face from their usage of each of the applicant’s products and services; and (g) Customer complaints and dispute resolution.

PSP/EMI
APPLICATION
FORM
PART E – INFORMATION TO BE PROVIDED BY E-MONEY ISSUERS
ONLY
In addition to the information provided in Parts B to D above, EMIs are required to provide the following:
17 PROPOSED BUSINESS PLAN (must be provided along with Part C above) – to be enclosed with the application and should include the following:
Attached
Yes/No
Please indicate document and page number
17.1 A description of the proposed e-money business, operations and
activities.
17.2 Details on the transactional limits and wallet sizes in accordance with
Schedule 2 of the E-Money Issuer (Amendment) Order, 2023 (EMI
Amendment Order).
17.3 Details on the internal controls that will be implemented to ensure that
wallet and transaction limits for individuals and businesses will be enforced. 19 SAFEGUARDING OF CUSTOMER’S FUNDS (Clause 10 of the EMI Order.) Attached Yes/No Please indicate document and page number
19.1 Evidence of the establishment of a custodial account (copy of the
bank’s letter clearly stating the type of account).
19.2 Evidence of establishment of adequate liquidity in a segregated bank
account specifically for operating expenses (copy of the bank’s letter clearly stating the type of account and showing funds deposited).
19.3 Policy and Procedure showing that the applicant has implemented
measures to ensure that customers can retrieve funds in the event of the failure of the EMI or any other event requiring mass conversion of electronic value into cash. 20 RISK MANAGEMENT Attached Yes/No Please indicate document and page number
20.1 Anti-Money Laundering and Combatting Terrorist Financing
Compliance Programme in accordance with clause 11(2)(e) of the EMI Order and the Central Bank’s AML/CFT Requirements for EMIs. 18 CAPITAL REQUIREMENTS Attached Yes/No Please indicate document and page number
18.1 Evidence that the EMI has the required initial capital to
mitigate risks. Please see Schedule 2 “E-Money Accounts – Transactional Limits and Capital Requirements” of the EMI Amendment Order. Please append a copy of the commercial bank’s letter clearly stating the type of account and showing funds deposited.
18.2 Details on how the applicant intends to meet the minimum
capital requirement if they are unable to do so at the point of application.

PSP/EMI
APPLICATION
FORM
21 AGENT AND AGENT MANAGEMENT Attached
Yes/No
Please indicate document and page number
21.1 All information requested in Schedule 3 “Agent Arrangement and
Management” of the EMI Order.
22 APPLICATION FEES Attached
Yes/No
Please indicate document and page number
22.1 Evidence of Payment of the non-refundable application fee payable
to the Central Bank in accordance with clause 5(4) and Schedule 1 of the EMI Order. Please provide a copy of the receipt showing proof of payment. Instructions for the electronic payment of the application fees can be found here. WHERE DOCUMENTS REQUIRED FOR SUBMISSION HAVE NOT BEEN PROVIDED BY THE APPLICANT, PLEASE PROVIDE A LIST AND REASONS FOR THE EXCLUSION.
PART F – DECLARATION
We, __________________________________________________________________ declare that:
(NAME OF APPLICANT IN BLOCK CAPITALS)

• We are aware that the Central Bank may refuse the application for a PSP or EMI if the applicant fails to satisfy
  the Central Bank that the applicant (including its officers, employees and controlling or significant shareholders) are fit and proper persons.
• We have read the Fit and Proper Guidelines (“F&P Guidelines”) issued by the Central Bank and in submitting
  this form, we are satisfied that the applicant (including its officer, employees and substantial shareholders) are fit and proper based on the criteria stated in the F&P Guidelines.
• We are aware that the policies and procedures in relation to the duties of registered PSP or EMI should be put in
  place with documentation readily available upon request.
• We undertake to notify the Central Bank of any material changes to or affecting the completeness or accuracy of
  the information provide in this application and supporting documentation within thirty (30) days upon these changes taking place or coming to our attention.
• All information given in this application is complete and accurate to the best of our knowledge, information and
  belief and that there are no other facts relevant to this application of which the Central Bank of Trinidad and Tobago (Central Bank) should be made aware.
• We acknowledge that knowingly or recklessly giving the Central Bank information which is false or misleading
  may be a criminal offence.
  (This Declaration to be signed by two (2) Directors of the company) Name Designation Signature Date

PSP/EMI
APPLICATION
FORM
APPENDIX 1: SAMPLE APPLICATION LETTER – PAYMENT SERVICE PROVIDER
DATE
From: (Applicant’s Name and Registered address) To: Payments and Financial Markets Infrastructure (PFMI) Department Central Bank of Trinidad and Tobago Eric Williams Plaza, Independence Square, PO Box 1250, Port of Spain. Dear Sir, Application to register as a Payment Service Provider pursuant to Section 36(cc) of the Central Bank Act Chap.79:02 [Name of Company] is applying to be registered as a Payment Service Provider (PSP) pursuant to
Section 36(cc) of the Central Bank Act Chap.79:02 and the Payments System Guideline No. 3 -
Operation of Payment Service Providers.
Attached are the Application form and documents in support of [Name of Company] of the PSP application. We declare to the best of our knowledge that the information furnished is true, correct and complete. Name:
Designation:
Company Stamp:

PSP/EMI
APPLICATION
FORM
APPENDIX 2: SAMPLE APPLICATION LETTER – E-MONEY ISSUER
DATE
From: (Applicant’s Name and Registered address) To: Payments and Financial Markets Infrastructure (PFMI) Department Central Bank of Trinidad and Tobago Eric Williams Plaza, Independence Square, PO Box 1250, Port of Spain. Dear Sir, Application to register as an E-Money Issuer pursuant to the E-Money Issuer Order, 2020 (as amended) [Name of Company] is applying to be registered as an E-Money Issuer (EMI) pursuant to the E-Money Issuer Order, 2020 (as amended) (Order). Further, as per the Order, [Name of Company] is also applying to be registered as a Payment Service Provider pursuant to Section 36(cc) of the Central Bank Act Chap. 79:02. Attached are the Application Form and documents in support of [Name of Company] of the EMI application. We declare to the best of our knowledge that the information furnished is true, correct and complete. Name:
Designation:
Company Stamp: