Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1698839203727.pdf (Saint Vincent and the Grenadines)
APPLICATION FOR THE REGISTRATION OF NON-REGULATED SERVICE PROVIDERS (NRSPs) Pursuant to Section 155(1) of the Proceeds of Crime Act 2013, a Non-Regulated Service Provider shall not carry out any type of relevant business in or from within St. Vincent and the Grenadines unless registered by the FIU.

SECTION I 1.

Name of Legal Entity/Individual: 2.

Nature of Business: Real Estate Agent () Car dealer() Attorney/ Notary() Accountant/Auditor() Jeweller() Casino() 3.
Country of incorporation / establishment: 4.

Date of incorporation / establishment1: 5.

Registered Office (if applicable): 6.

Principal business address in Saint Vincent and the Grenadines: 7.

Mailing address in Saint Vincent and the Grenadines (if different) 8.

Website address (if applicable): 9.

Are there offices located outside of Saint Vincent and the Grenadines?

If yes, please list each office and the jurisdiction below.

SECTION II 10.
SECTION II 10.

Tick all relevant boxes to describe the type of service carried out or to be carried out by your business/company a.

Acts as a real estate agent involved in transactions concerning the buying and selling of real estate.

What is the predominant nature of the business?

Commercial Residential Other specify________________________________ b.
Provides gambling services (including internet gambling) or operates casinos or common gaming houses 1 Provide copy of the Articles and Certificate of Incorporation.

c. Provides the service of selling or leasing new or used motor vehicles.
d. Deals and trades in goods, including precious stones and precious metals e. Lawyers / Notaries preparing transactions for clients concerning the following activities– (i) buying and selling of real estate (ii) managing of client money, securities or other assets (iii) management of bank, savings or securities accounts (iv) organisation of contributions for the creation, operation or management of companies (v) creation, operation or management of legal persons or legal arrangements and buying and selling of business entities f. Accountants / Auditors preparing transactions for clients concerning the following activities– (i) buying and selling of real estate (ii) managing of client money, securities or other assets (iii) management of bank, savings or securities accounts (iv) organisation of contributions for the creation, operation or management of companies (v) creation, operation or management of legal persons or arrangements, and buying and selling of business entities g. Other Independent Legal Professionals preparing transactions for clients concerning the following activities– (i) buying and selling of real estate (ii) managing of client money, securities or other assets (iii) management of bank, savings or securities accounts (iv) organisation of contributions for the creation, operation or management of companies (v) creation, operation or management of legal persons or arrangements, and buying and selling of business entities SECTION III 11.
State the number of employees: 12.

Details of the Compliance/Reporting Officer Name: ________________________________________ Address: ________________________________________ Nationality: ________________________________________ ID#, DP#, PP# (Any 2): ______________________________ Telephone: _________________________________________ Email: _________________________________________ Fax: _________________________________________ 13.
List the date of appointment of all directors and senior officers of the business / company.2 Full Name Director(s) of Address Job title/role Nationality Date of appointment ID#,DL#, PP# ( Any 2) Contact info 1.

2.

3.

4.

5.

14.

List all beneficial owners, partners and principals of the business / company.

of Full Beneficial Owner (s) Name Address Percentage Interest Nationality ID#, DL#, PP# ( Any 2) Contact info 1.

2.

3.

4.

5.

15.
2.

3.

4.

5.

15.

(a) Have any of the directors/officers ever been convicted of any criminal offences?

Yes No (b) Have any of the directors/officers ever been arrested, detained, charged, indicted or summoned to answer for any criminal offence of which the result is still pending?

Yes No If you have answered yes to either (a) or (b) please give details (list all cases without exception).
____________________________________________________________________________________________ ____________________________________________________________________________________________ 16.

Is the business regulated by a foreign regulatory authority?

Yes No If yes, name the regulator and provide a copy of license or registration _____________________________ ______________________________________________________________________________________ 17.

Kindly provide a copy of your business plan.


2 Provide an organizational chart and audited financial statements (if available) OR unaudited financial statements for the last 2 years plus unaudited accounts for the period ending in the quarter most recently completed.

SECTION IV 18.

Please indicate the composition of your business clientele, in percentage terms.

a.

Foreign Politically Exposed Persons 3_____ b.


Domestic Politically Exposed Persons 4________ c. Clients from International Organisations5 _______ d. High net-worth individuals6______ e. Non-Resident or Overseas Clients._____ f. Clients with foreign business_____ g. Clients that are legal arrangements 7 ______ h. Clients that are legal entities/persons8 _________ i.

Professional Intermediaries9 _________ i. Resident _________ j.

Other Please specify _________ 19.


Kindly state the Annual Income of your Business/ Company.

$_________________(EC) 20.

What percentage of business revenue is derived from the methods of payment in the table below?
Type of Payment Percentage (%) Cash Cheque Bank Drafts Wire Transfer Credit Cards Debit Cards Other(Please Specify 3 Foreign Politically Exposed Persons are individuals who are or have been entrusted with prominent public functions by a foreign country such as Heads of State or of government; senior politicians; senior government, judicial or military officials; senior executives of state owned corporation;, important political party officials.
4 Domestic Political Exposed Persons are individuals who are or have been entrusted domestically with prominent public functions, i.e.

Heads of State or of government; senior politicians; senior government, judicial or military officials; senior executives of state owned corporations; important political party officials.

5 These are persons who are or have been entrusted with a prominent function by an international organization, i.e.
directors, Deputy Directors and Members of the Board or equivalent functions.

6 High net-worth individuals are persons holding financial assets (excluding their primary residence) with a value greater than $1 million dollars (EC).

7 Legal Arrangement refers to express trusts or other similar legal arrangements such as fiducie, treuhand and fideicomiso.

Express trust refers to a trust clearly created by the settlor, usually in the form of a document, example, a written Deed of Trust.
They are to be contrasted with trusts which come into being through the operation of the law and which do not result from the clear intent or decision of a settlor to create a trust or similar arrangement.

8 Legal persons refer to any entities other than natural persons that can establish a permanent customer relationship with a financial institution or otherwise own property such as companies, body corporate, foundations, partnership, associations and other relevantly similar entities.
9 Intermediary means a person who has or seeks to establish a business relationship or to carry out an occasional transaction on behalf of his or her customer / client with a service provider, so that the intermediary becomes a customer of the service provider.

SECTION V This application to register as a non-regulated service provider is made under regulation 3 of the Anti-Money Laundering and Terrorist Financing (Non-Regulated Service Providers) Regulations, 2022.
I declare that to the best of my knowledge and belief all the information I have given in this application is correct.
I am aware that, under regulation 12 of the Anti-Money Laundering and Terrorist Financing (Non-Regulated Service Providers) Regulations 2022, it is an offence to – (a) provide any information, make any representation or submit any document that I know, suspect or have reasonable grounds to suspect to be false or materially misleading or do not believe to be true; or (b) recklessly provide any information, make any representation or submit any document or return that is false or materially misleading.
And a Non-Regulated Service Provider who commits this offence is liable – (a) on summary conviction to a fine of $50,000 or to imprisonment for two years or to both; or (b) on conviction on indictment to a fine of $100,000 or to imprisonment for two years or to both.
I understand that it is a requirement under regulation 9 of the Anti-Money Laundering and Terrorist Financing (Non-Regulated Service Providers) Regulations 2022 that the Financial Intelligence Unit be provided with written notice of any change in the information required to be registered under regulation 3.
Name: _____________________________________ Signature: __________________________________ Position: ____________________________________ Date: _______day of ______________20__________ FOR OFFICIAL USE ONLY