Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1696585710111.pdf (Vanuatu)
Vanuatu Financial Intelligence Unit REGISTRATION FORM FOR REPORTING ENTITY Pursuant to section 9(3) of the Anti-Money Laundering & Counter-Terrorism Financing Act No.

13 of 2014, persons carrying on a business stipulated under section 2 of the said Act are required to register the business with the Director.

PART A: Detail of Applicant 1.

Name of Applicant:__________________________________________ 2.
Name of the Business (under which the applicant is carrying on a business or proposes to carry on a business and registered under Business Name Act): ____________________________________________________________________________ 3. Business Structure (sole trader, partnership, company or legal arrangement): ____________________________________________________________________________ 4.
Full Business Address (unit no, floor level, Building, Compound, Street, location proximity, CBD, Island, Province): ____________________________________________________________________________ 5. Business CT No.

: ___________________________________________________________ 6.

VFSC Registration No., RBV Licence No.

etc…:__________________________________ 7.


Overseas Registration or Licensing Detail: _____________________________________ 8. Business Telephone No.s: ___________________________________________________ 9. Business Facsimile No.s: ____________________________________________________ 10. Business Email Address: ___________________________________________________ 11. Business Postal Address: __________________________________________________ 12.
Description of the Business carried on or proposed to be carried on (refer to schedule 1): ____________________________________________________________________________ ____________________________________________________________________________ 13.

Detail of Business (whether it is a subsidiary of another entity and controlled by another entity): ____________________________________________________________________________ ____________________________________________________________________________ 14.
Detail and location (full street address) of Business’ affiliates, branches, subsidiaries and/or agents in Vanuatu): ____________________________________________________________________________ ____________________________________________________________________________ PART B: Detail of Beneficial Ownership 15.
Disclose the business's source of funds/equity/capital (Include supporting documents/proof of source of funds/equity/capital): ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 16.
Name and Residential Address of Beneficial Owners or similar positions (including copy of passport or other ID) and corresponding percentage of the ownership: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 17.
Name, Title, Residential Address and brief role/responsibility description of each senior management officials or similar positions of the business (including copy of passport or other ID): ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 18.
For each person listed under 16 and 17, disclose their immediate family members (Parents, Siblings, Spouse, Children and Dependents): ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 19.
For each person listed under 16 and 17, disclose their close associates that have been subject to adverse reporting/record (in the past 10 years) and those who are classified as PEPs (in the past 10 years): ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 20.
Named persons under 16 and 17 subject to adverse reporting in the past 10 years: (charged, prosecuted and/or convicted in relation to money laundering, financing of terrorism and other serious offence under the Penal Code, Counter Terrorism & Transnational Organised Crime or the AML&CTF Act; or has been the subject of civil or criminal proceedings or enforcement action, in relation to the management of an entity, which were determined adversely to the mentioned person(s) and which reflected adversely on the applicant’s or the named persons’ competence, diligence, judgment, honesty and integrity) ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ PART C: Detail of Applicant’s Agent, Branch or Subsidiary (“Affiliate”) 21.
Full name of the person who is proposed to be registered as an affiliate of the applicant or which the applicant wishes to affiliate with: ____________________________________________________________________________ ____________________________________________________________________________ 22. Business Name under which the other person is carrying on a business or proposes to carry on a business: ____________________________________________________________________________ ____________________________________________________________________________ 23. Business Structure (sole trader, partnership, company or legal arrangement): ____________________________________________________________________________ 24.
Full Business Address (unit no, floor level, Building, Compound, Street, location proximity, CBD, Island, Province): ____________________________________________________________________________ ____________________________________________________________________________ 25. Business CT No.

:_________________________________________________________ 26.

VFSC Registration No., RBV Licence No.

etc…__________________________________ 27.


Overseas Registration or Licensing Detail:_____________________________________ 28. Business Telephone No.

:___________________________________________________ 29. Business Facsimile No._____________________________________________________ 30. Business Email Address:____________________________________________________ 31. Business Postal Address:___________________________________________________ 32.
Description of the Business carried on or proposed to be carried on: ____________________________________________________________________________ ____________________________________________________________________________ 33.Date on which the applicant commenced or is to commence offering the registrable business:____________________________________________________________________ 34.
Detail of Business whether it is a subsidiary of another entity, and controlled by another entity: ____________________________________________________________________________ ____________________________________________________________________________ PART D: Detail of Authorized Personal in the Applicant’s Affiliate 35.
Name, Address and percentage of Beneficial Owners of the Affiliate (including copy of passport or other ID): ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 36.
Name, Address and role/responsibility of each senior management officials of the Affiliate (including copy of passport or other ID): ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 37.
For each person listed under 35 and 36, disclose their immediate family members (Parents, Siblings, Spouse, Children and Dependents): ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 38.
For each person listed under 35 and 36, disclose their close associates that have been subject to adverse reporting/record and those who are classified as PEPs: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 39.
Named persons under 35 and 36 subject to adverse reporting in the past 10 years: (charged, prosecuted and/or convicted in relation to money laundering, financing of terrorism and other serious offence under the Penal Code, Counter Terrorism & Transnational Organised Crime or the AML&CTF Act; or has been the subject of civil r criminal proceedings or enforcement action, in relation to the management of an entity, which were determined adversely to the named person(s) and which reflected adversely on the named persons’ competence, diligence, judgment, honesty and integrity) ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ PART E: Consent of Registration 40.
Name of person completing the registration form:________________________________ 41.

Position of person within the business: _________________________________________ 42.

Whether management approval has been sought:________________________________ 43.

Signature of Person, Applicant and management: Schedule 1 Domestic Bank Offshore Bank Casinos, Gaming (e.g.

slot machines), Lottery (e.g.

“chances”) Interactive Gaming (e.g.


online betting) Real Estate Vehicle Dealership Credit Union Co-operative Society Law Firm ( managing of funds, accounts, securities or property) Accounting Firm (managing of funds, accounts, securities or property) Trust & Company Service Provider Nominee shareholder for another person Precious Metal & Stone Dealer Property in excess of a million vatu ( e.g.
yachts) Acceptance of Deposit Lending Financial Leasing Money or Value Transfer Issuing & Managing means of payment Financial Guarantees and Commitment Money Market Instrument Foreign Exchange, Money Exchange and value exchange (e.g.
pawn shops) Exchange rate instruments Interest rate instruments index instruments Transferrable security Futures trading Financial Futures and option Commodities futures trading Participation in securities issues Mutual funds, individual or collective portfolio management Insurer Insurance Broker Insurance Agent Insurance Re-Insurer Insurance Manager Loss Adjuster Charitable Associations Founder, councilor, secretary or guardian of Foundation Securities Dealers Administering or managing funds on behalf of international companies or any other persons Manager of Unit Trust Futures Broker Delivery of currency & payroll Superannuation (apart from VNPF) Money brokering Administration and safekeeping of cash and liquid securities E-Business