Eligible Introducer Certificate (F1)

Eligible Introducer Certificate (F1) (To be completed by an Eligible Introducer conducting relevant financial business) NAME OF APPLICANT: .............................................................................................................................. ADDRESS OF APPLICANT: ...................................................................................................................... ................................................................................................................................................................. ................................................................................................................................................................. I/We certify that in accordance with the provisions of the Proceeds of Crime Act 2015, and the GFSC’s AML/CFT/CPF Guidance Notes as amended from time to time, or equivalent legislation, to implement the relevant legislative and regulatory requirements and obligations. I/We certify that: • We have verified the identity of the Applicant and confirm that documentary evidence has been obtained and identity checks have been undertaken to confirm that the applicant(s) name(s) and address(es) as shown on the Applicant Form(s) is correct. • We have verified the original documentation and the information contained therein. We attach copies of the documentation to this certificate, confirm that any additional KYC original documentation will be retained in our records, and that we will make these available on request to yourselves without delay upon request. • The Applicants(s) is/are applying on his/her own behalf and not as nominee, trustee or in a fiduciary capacity for any other person. Name of Eligible Introducer: ............................................................................................ FSC Permission/Authorisation Number: .................................................................................

This form must be signed by two senior officers of the Eligible Introducer. Signed: ............................................... Full Name: Job Title: ........................................... Date: Signed: ............................................... Full Name: Job Title: ........................................... Date: .................................................................. Notes to an Eligible Introducer completing this Certificate

1. The full name and address of the applicant must be given at the top of the Certificate. The wording may be either adapted for joint account holders or a separate certificate completed for each. [Where the applicant is a Trust, a separate Certificate must be completed in respect of each Trustee or settlor whose identity has been verified].
2. The complete Certificate may be used by the institution as evidence of the identity and address of the applicant and should be retained on file by the institution for the required period.
3. Although identity must be verified without applying any exemptions or concessions that might be normally available to the Eligible Introducer, it is not necessary for the Eligible Introducer, to provide details of how the verification was carried out.
4. The Certificate must be signed by two senior officers of the Eligible Introducer and details of the Eligible Introducer’s firm, etc., inserted as shown. If an incomplete Certificate is received, it should be returned immediately to the Eligible Introducer for completion.