Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1696579049166.pdf (Vanuatu)
CLASSIFIED Template G Application Vanuatu Financial Intelligence Unit SANCTIONS SECRETARIAT Application for authorisation to use or deal with property or make property or a financial service available to a designated person or entity under section 15 of the United Nations Financial Sanctions Act No.
6 of 2017 The following information is required in order to assess your application for authorisation to use or deal with property or make property or financial services available under the United Nations Financial Sanctions Act No.

6 of 2017 (the Act).

The information you give may be disclosed in accordance with section 28 of the Act.

Details of Applicant Applicant/Company Name: Applicant's Postal Address: Applicant's Permanent Address (if different): Contact Person's Name: Telephone No.
: Facsimile No.

: E-mail Address: Mobile No.
: Applicant's relationship to designated person (if not designated person themselves): Type of application This is an application for permission to (tick appropriate box): Use or deal with frozen property Make property or financial service available to a designated person/entity Complete Section A Complete Section B Section A Use or dealing with frozen property Describe the frozen property to be used or dealt with: The identity of the designated person/entity who owns/controls the property: Proposed use or dealing Permissible basis under Subsection 17 (2) of the Act (tick appropriate box): basic expense contractual obligation extraordinary expense Purpose of use or dealing (e.g.
paying rent or mortgage): Beneficiary of use or dealing: Section B Making property/ financial service available to designated person/entity Describe the property or financial service to be made available: The identity of the designated person or entity to whom property or financial service is to be made available: Proposed property or financial service Permissible basis under Subsection 17 (2) of the Act (tick appropriate box): basic expense contractual obligation extraordinary expense Purpose of making property or financial service available (e.g.
paying rent or mortgage): Beneficiary of property or financial service being made available: Declaration by Applicant Warning: a person who makes a declaration that is false in a material particular is guilty of a misdemeanour under the Criminal Code Act 1974 and a penalty of imprisonment for up to three years may apply I hereby declare that the details provided in this application are true and correct.
Name Occupation Signature Date Certificate regarding Applicant Applicants need a person who has known them personally for at least 3 years to declare that the statement they have made is true.

This declaration must be witnessed by a Notary Public.

Warning: a person who makes a declaration that is false in a material particular is guilty of a misdemeanour under the Criminal Code Act 1974 and a penalty of imprisonment for up to three years may apply.
A Notary Public who wilfully certifies or propounds any false statement or document or who fraudulently with intent to deceive, withholds or perverts any fact or document pertinent to the subject of protest or any other notarial act shall be guilty of an offence under the Notaries Public Act 1988 and shall be liable to imprisonment for a term not exceeding 2 years.
I hereby declare that I have known personally the Applicant for a period of more than 3 years and that the statement made by the Applicant in this form is true to the best of my knowledge and belief.

No fee has been charged for this certificate.

Name Address Occupation Telephone/Mobile Applicant's Name Signature Date Witness name Witness occupation Signature Date Notes Office Use Only Date received: Application number: Required fields: Fields yet to complete: Processing officer: Employment number: