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Schedule 2

(Regulation 3)

FORM 1

APPLICATION FOR BROKER DEALER, LIMITED SERVICE BROKER OR CUSTODIAN LICENCE

Application for a broker dealer*, limited service broker* or custodian* licence under the Act is made as follows:

(* delete as inapplicable)

Notes:

(1) If space is insufficient to provide details, please attach annexure, and the annexure should be identified as such and signed by the signatory to this application.

(2) This application must be accompanied by the last audited balance sheet and profit and loss account certified as required by regulation 5.

Part 1
INFORMATION ON THE APPLICANT
1.	(a)	Name of applicant:
	(b)	Registered office:	____________
	(c)	Place of incorporation:	____________
	(d)	Full address and telephone number of the principal place at which the business of the applicant is to be carried on:
	(e)	The authorised and paid-up capital of the applicant, including the types of shares issued:	____________ ____________
	(f)	Details of shareholders of the applicant, including the name, address, amount of shares being held and date of acquisition:

Name

Address

Amount of Shares

Date of Acquisition

(g)

Address of place at which applicant's register under section 86 of the Act will be kept:

(h)

Set out as an annexure to this application details of each director and senior officer showing the full name, residential address, date of birth, academic qualifications and experience, office held and date of appointment:

(i)

Set out as an annexure to this application details of each (prospective) principal and representative showing full name, date of birth, residential address, academic qualifications and experience.

State the nature of the principal business of the applicant:

(a)

State in detail the activity and the manner in which the applicant proposes to conduct the business for which the applicant requires a licence:

(b)

The type of clients with whom the applicant proposes to do business:

(c)

Describe in detail the organisational structure and internal control procedures which the applicant has adopted or proposes to adopt for its proposed business:

Name and address of auditors or proposed auditors:

Name and address of attorneys-at-law or proposed attorneys-at-law:

Name and address of bankers or proposed bankers

If the company is a subsidiary of another company, give the name, address, nature of business of parent company:

Give the name and address of subsidiaries, if any, of the company or any enterprise in which it has a shareholding or similar interest, give details and nature of business pursued:

Set out the name and address of each person who, directly or indirectly, exercises or has power to exercise a controlling influence over the management and policies of the applicant other than those shown as directors:

Name

Address

10.

Is any director or principal of the applicant a director of any other company?

Using an annexure, answer “Yes” or “No” for each person; if “Yes”, give details of:

(a)

names of companies;

(b)

places of incorporation; and

(c)

dates of appointment.

(For questions 6 to 8, answer “Yes” or “No” in the space provided. If “Yes”, attach annexure giving all relevant particulars.)

11.

Has the applicant or any director, principal or representative of the applicant within the past 10 years

Answer

(a)

been licensed or registered in any place under any law which requires licensing or registration in relation to securities business

_______________

(b)

been licensed, registered or otherwise authorised by law to carry on any trade, business or profession in any place?

_______________

(c)

been refused the right or restricted in its or his or her right to carry on any trade, business or profession for which a specific licence, registration or other authority is required by law in any place?

_______________

12.

Has any director, principal or representative of the applicant within the past 10 years

Answer

(a)

been a member or partner in a member firm of any securities exchange?

_______________

(b)

been suspended from membership of any securities exchange or otherwise disciplined by a securities exchange?

_______________

(c)

been refused membership of any securities exchange?

_______________

(d)

been known by any name other than the name or names shown in this

(e)

been convicted of any offence other than a traffic offence in Saint Lucia or elsewhere or are there any proceedings now pending which may lead to such a conviction?

_______________

(f)

had judgement including findings in relation to fraud, misrepresentation or dishonesty been given against the applicant in any civil proceedings, in Saint Lucia or elsewhere? (If “Yes”, using an annexure, give full details, including whether judgement is unsatisfied.)

_______________

(g)

been declared bankrupt or compounded with or made an arrangement for the benefit of the applicant's creditors, in Saint Lucia or elsewhere?

_______________

(h)

been engaged in the management of any company other than those referred to in answer to question 5?

_______________

(i)

been refused a fidelity or surety bond in Saint Lucia or elsewhere?

_______________

(j)

been disqualified as a director, or been director of a company that has gone into receivership or liquidation, in Saint Lucia or elsewhere?

_______________

13.

Has any director, principal or representative of the applicant had any experience in performing the functions in relation to the proposed activity of the applicant referred to in question 3?

14.

In relation to each director, principal or representative of the applicant, set out below details of the officer's employment and business activities, during the previous 10 years:

Name of
Director, principal or representative

Name and
address of employer (if
self-employed
so state)

Nature of business

Description
of duties in relation to the employment
or activity

Period of employment
or activity (give exact dates)

15.

Set out any additional information (including any formal qualifications or training of the directors, principal and representative of the applicant and the name of the institution that conducted the course) considered relevant to this application.

Name of Character Referee

Address of
Character Referee

Occupation
of Character Referee

Name of Director,
principal or
representative in respect
of whom enquiries may
be made

Part 2
MISCELLANEOUS
We declare that all information given in this application and in the attached annexure (if any) is complete and accurate to the best of our knowledge and belief.
Dated this ______ day of ____________
_________________________	_________________________
*Signature	Signature
__________________________ __________________________
(Name of Director)	(Name of Director/Principal)**
Dated this _____ day of ____________
______________________
Signature
______________________
Justice of the Peace/Attorney-at-Law
* This application is to be signed by two directors, or a director and a principal of the applicant.
** Delete whichever is inapplicable.

FORM 2

APPLICATION BY AN INDIVIDUAL FOR INVESTMENT ADVISER LICENCE
Application for an investment adviser licence under the Act is made as follows:
Note:
(1) If space is insufficient to provide details, please attach annexure, and the annexure should be identified as such and signed by the signatory to this application.
(2) This application must be accompanied by a detailed statement of the applicant's assets and liabilities and shall be signed by the applicant.
1.		Personal particulars of the applicant
	(a)		Name of applicant:
	(b)		Full address and telephone number of the principal place at which the business of the applicant is or is to be carried on:
	(c)		Residential address:
	(d)		Address of place at which applicant's register under section 86 of the Act will be kept:
2.	(a)		Indicate area of proposed business for which the applicant requires an investment adviser licence:
			advising others concerning securities,

			issues or promulgates analyses or reports concerning securities,

			pursuant to a contract or arrangement with a customer, undertakes on behalf of the customer (whether on a discretionary authority granted by the customer or otherwise) the management of a portfolio of securities for the purpose of investment.


	(b)		For each indicated area of proposed business, state in detail the manner in which the business will be conducted and the experience of the applicant and the management staff in that business.
	(c)		Describe in detail the organisational structure and internal control procedures which the applicant has adopted or proposes to adopt in the conduct of the business.
3. The type of customers with whom the applicant proposes to do business.
4. Is the business of investment adviser the principal business carried on by the applicant? (Answer “Yes” or “No”. If “No”, give details of the applicant's principal business.)
5. Does the applicant have an interest in one or more shares in any company the shares of which are quoted on a securities exchange, the aggregate of the nominal amount of which constitutes not less than 5% of the aggregate of the nominal amount of all the issued shares of the company? (Answer “Yes” or “No”. If “Yes”, give full details of the interest including names of companies and percentage of interest.)
6. Is the applicant a director of any company in Saint Lucia or elsewhere? (Answer “Yes” or “No”.) If “Yes”, using an annexure, give details of
	(a)		names of the companies;
	(b)		places of incorporation; and
	(c)		the relevant interests.
(Answer the following questions “Yes” or “No” in space provided. If “Yes”, attach annexure giving all relevant particulars.)
7. Has the applicant within the past 10 years
							*Answer*
	(a)		been licensed or registered in any place under any law which requires licensing or registration in relation to dealing in securities or acting as an investment adviser?				_______________
	(b)		been licensed, registered or otherwise authorised by law to carry on any trade, business or profession in any place?				_______________
	(c)		been refused the right or restricted in the applicant's right to carry on any trade, business or profession for which a specific licence, registration or other authority is required by law in any place?				_______________
	(d)		been a member or partner in a member firm of a securities exchange?				_______________
	(e)		been suspended from membership of any securities exchange or otherwise disciplined by a securities exchange?				_______________
	(f)		been refused membership of any securities exchange?				_______________
	(g)		carried on business under any name other than the name or names shown in this application?				_______________
	(h)		been convicted of any offence other than a traffic offence in Saint Lucia or elsewhere or are there any proceedings now pending which may lead to such a conviction? (If “Yes” attach annexure giving full details of the conviction(s) or proceeding(s).)				_______________
	(i)		had judgement including findings in relation to fraud, misrepresentation or dishonesty been given against the applicant in any civil proceedings, in Saint Lucia or elsewhere? (If “Yes” attach annexure giving full details, including whether judgement is unsatisfied.)				_______________
	(j)		been censured or disciplined by any professional body, society or association of which the applicant was or is a member? (If “Yes”, attach annexure giving full details, including name of the professional body, society or association.)				_______________
	(k)		been declared bankrupt or compounded with or made an assignment for the benefit of the applicant's creditors in Saint Lucia or elsewhere?				_______________
	(l)		being engaged in the management of any company other than a company referred to in answer to question 6?				_______________
	(m)		been refused a fidelity or surety bond in Saint Lucia or elsewhere?				_______________
	(n)		been disqualified as a director, or been a director of a company that has gone into receivership or liquidation, in Saint Lucia or elsewhere?				_______________
1. Set out below details of the applicant's employment and business activities during the previous 10 years.
Name and address of employer (if self- employed so state)				Nature of Business		Description of duties in relation to the employment or activity			Period of employment (give exact dates)
1.
2.
3.
4.
9. Set out below details of two persons (who must not be related to the applicant, and neither of whom has any interest in the success or otherwise of this application) with whom the applicant has had regular contact over the past 5 years and of whom the Commission may enquire regarding the applicant's character and reputation.
Name					Address			Occupation
1.
2.
10. Set out any additional information (including any formal qualifications or training and the name of the institution that conducted the course) considered relevant to this application:
11. I declare that all information given in this application and in the attached annexure (if any) are true and correct.
Dated this ____ day of _____________
___________________________
Signature

FORM 3

APPLICATION BY A COMPANY FOR INVESTMENT ADVISER LICENCE

Application for an investment adviser licence under the Act is made as follows:

Notes:

(1) If space is insufficient to provide details, where necessary, please attach annexure, and the annexure must be identified as such and signed by the signatory to this application.

(2) This application must be accompanied by the last audited balance sheet and profit and loss account certified as required by regulation 5.

Part 1

INFORMATION ON THE APPLICANT

(a)

Name of applicant:

(b)

Registered office:

(c)

Place of incorporation:

(d)

Full address and telephone number of the principal place at which the business of the applicant is or is to be carried on:

(e)

The authorised and paid-up capital of the applicant, including the types of shares issued or to be issued:

(e)

The details of shareholders of the applicant, including the name, address, amount of shares being held and date of acquisition

_______________

Names

Address

Amount of
Shares

Date of
acquisition

(g)

Address of place at which applicant's register under section 86 of the Act will be kept:

(h)

(i)

Set out as an annexure to this application details of each (prospective) principal and representative showing full name, date of birth, residential address, academic qualifications and experience.

2. State the nature of the principal business of the applicant:

(a)

Indicate areas of proposed business for which the applicant requires an investment adviser licence:

advises others concerning securities.

issues or promulgates analyses or reports concerning securities.

pursuant to a contract or arrangement with a customer, undertakes on behalf of the customer (whether on a discretionary authority granted by the customer or otherwise) the management on behalf of customers of a portfolio of securities for the purpose of investment.

(b)

For each indicated area of proposed business, state in detail the manner in which the business will be conducted and the experience of the applicant and its management staff in that business.

(c)

The type of customers with whom the applicant proposes to do business.

(d)

Describe in detail the organisational structure and internal control procedures which the applicant has adopted or proposes to adopt in the conduct of the business.

4. Name and address of auditors or proposed auditors.

5. Name and address of attorneys-at-law or proposed attorneys-at-law.

6. Name and address of bankers or proposed bankers.

7. If the company is a subsidiary of another company give the name, address, and nature of business of the parent company.

8. Give the name and address of subsidiaries, if any, of the company, or any enterprise in which it has a shareholding or similar interest, give details and nature of business pursued.

9. Set out the name and address of each person who directly or indirectly exercise or has power to exercise a controlling influence over the management and policies of the applicant other than those shown as directors:

Name

Address

10. Is a director of the applicant a director of any other company? Using an annexure, answer “Yes” or “No” for each person; if “Yes”, give details of:

(a)

names of company;

(b)

places of incorporation; and

(c)

dates of appointment.

(For questions 6 and 7 answer “Yes” or “No” in the space provided. If “Yes” attach annexure giving all relevant particulars.)

11. Has any director of the applicant within the past 10 years

(a)

been licensed or registered in any place under any law which requires licensing or registration in relation to dealing in securities or acting as an investment adviser?

_______________

(b)

been licensed, registered or otherwise authorised by law to carry on any trade, business or profession in any place?

_______________

(c)

_______________

12. Has any director of the applicant within the past 10 years

Answer

(a)

been a member or partner in a member firm of any securities exchange?

_______________

(b)

been suspended from membership of any securities exchange or otherwise disciplined by a securities exchange?

_______________

(c)

been refused membership of any securities exchange?

_______________

(d)

been known by any name other than the name or names shown in this application?

_______________

(e)

been convicted of any offence other than a traffic offence in Saint Lucia or elsewhere or are there any proceedings now pending which may lead to such a conviction?

_______________

(f)

_______________

(g)

been declared bankrupt or compounded with or made an assignment for the benefit of the applicant's creditors, in Saint Lucia or elsewhere?

_______________

(h)

been engaged in the management of any company other than a company referred to in answer to question 5?

_______________

(i)

been refused a fidelity or surety bond in Saint Lucia or elsewhere?

_______________

(j)

been disqualified as a director, or been a director of a company that has gone into receivership or liquidation, in Saint Lucia or elsewhere?

_______________

13. In relation to each director and staff management member of the applicant, set out below details of the officer's employment and business activities, during the previous 10 years:

Name of Director of
staff member

Name and address of employer (if self-
employed,
so state)

Nature
of business

Description of duties in
relation to the employment or activity )

Period of employment or activity (give
exact dates

14. Set out any additional information (including any formal qualifications or training of the directors, or management staff of the applicant and the name of the institution that conducted the relevant course) considered relevant to this application.

15. Set out below details of two persons (who must not be related to the applicant, and neither of whom has any interest in the success or otherwise of this application) with whom each director and management staff member of the applicant has had regular contact over the past 5 years and of whom the Commission may enquire regarding their character and reputation.

Name of
Character Referee

Address of Character
Referee

Occupation
of
Character

Name of Director or Management Staff Member in Respect
of Whom Enquiries
May be Made

Part 2
MISCELLANEOUS
We declare that all information given in this application and in the attached annexure (if any) is complete and accurate to the best of our knowledge and belief.
Dated this ______ day of ____________
_________________________	_________________________
*Signature	Signature
_________________________	_________________________
(Name of Director)	(Name of Director)
Dated this __________ day of __________
______________________________
Signature
______________________________
Justice of Peace/Attorney-at-Law
* This application is to be signed by two directors of the applicant.

FORM 4

APPLICATION FOR PRINCIPAL OR REPRESENTATIVE LICENCE

Application for a principal or representative* licence under the Act is made as follows:

(a)

Applicant's surname

Other names

(b)

Residential address

Telephone No.

(c)

Date of birth

Place of birth

(d)

No. of years applicant has resided in Saint Lucia

Nationality

(e)

Occupation for which licence is sought:

(f)

Full name of employer:

(g)

The full address at which the business of the employer is to be carried on:

Telephone No.

(h)

Nature of business of the principal/representative

(i)

Address of place at which Register under section 86 of the Act will be kept

(j)

Present remuneration arrangement with employer: salary, commission or both

(k)

Directorship in companies in Saint Lucia or elsewhere

* Delete whichever is inapplicable.

2. (Answer “Yes” or “No” in the space provided. If “Yes” attach annexure giving all relevant particulars.) Has the applicant within the past 10 years

(a)

been licensed or registered in any place under any law which requires licensing or registration to deal or trade in securities or act as principal or representative?

_______________

(b)

been licensed, registered, or otherwise authorised by law to carry on any trade, business or profession in any place?

_______________

(c)

been refused the right or restricted in the applicant's right to carry on any trade, business or profession for which a specific licence, registration or other authority is required by law in any place?

_______________

(d)

been a shareholder in a member firm of any securities exchange?

_______________

(e)

been suspended from membership of any securities exchange or otherwise disciplined by a securities exchange?

_______________

(f)

been refused membership of any securities exchange?

_______________

(g)

carried on business under any name other than the name or names shown in this application in paragraph 1 (a)?

_______________

(h)

been convicted of any offence, other than a traffic offence, in Saint Lucia or elsewhere or are there any proceedings now pending which may lead to such a conviction?

_______________

(i)

had judgement including findings in relation to fraud, misrepresentation, or dishonesty been given against the applicant in any civil proceedings, in Saint Lucia or elsewhere? (If “Yes”, attach annexure giving full details, including whether judgement is unsatisfied)

_______________

(j)

been refused a fidelity or surety bond, in Saint Lucia or elsewhere?

_______________

(k)

been declared a bankrupt or compounded with or made an assignment for the benefit of the applicant's creditors in Saint Lucia or elsewhere?

_______________

(l)

been disqualified as a director of a company, or been a director of a company that has gone into receivership or liquidation, in Saint Lucia or elsewhere?

_______________

Has the applicant had any experience in performing the functions of a principal or representative? (Answer “Yes” or “No”) If “Yes” attach annexure giving all relevant particulars

_______________

3. Set out below details of the applicant's employment and business activities during the previous 10 years:

Name and Address
of Employer (if self-employed so state)

Nature of Business

Description of
Duties in Relation
to the Employment
or Activity

Period of Employment or Activity (give
exact dates)

5. Set out below details of two persons (who must not be related to the applicant and neither of whom has any interest in the success or otherwise of this application) with whom the applicant has had regular contact over the past 5 years and of whom the Commission may enquire regarding the applicant's character and reputation:

Name

Address

Occupation

6. Does the applicant have an interest in one or more shares in any company, the shares of which are quoted on a securities exchange, the aggregate of the nominal amount of which constitutes not less than 5% of the aggregate of the nominal amount of all issued shares of the company? (Answer “Yes” or “No”. If “Yes”, give full details of the interest including the names of companies and percentage of interest).

7. Set out any additional information (including any formal qualifications or training of the applicant and the name of the institution that conducted the course) considered relevant to this application.

8. I declare that all information given in this application and in the attached annexure (if any) is complete and accurate to the best of my knowledge and belief.

Dated this ____ day of ___________________

Signature ____________________________

(Signed by Applicant)

Dated this _____ day of __________________

Signature ____________________________

Justice of the Peace/Attorney-at-Law

NOTE:

(a)

This application should be accompanied by a certificate in or to the effect of the following form:

To the Commission:

On the basis of due and diligent enquiry made of the background of the applicant named in this form who is in my direct employment or acting for or on behalf of me, and other information available, I believe the applicant to be of good character and reputation and to have the competence and experience to perform the function of a representative.

Dated this ____ day of ___________________

Signature ____________________________

Name______________________________

Capacity____________________________

(b)

The certificate should be signed by each licensee by whom the applicant is to be employed or for or by arrangement with whom the applicant is to act.

FORM 5

REGISTER OF SECURITIES
Name of person having an interest:
Particulars*	Acquired	Disposed of	Balance

Date	Name of Security	Unit Price	No. of Units	Cost	No. of Units	Proceeds	In Units


* State how securities were acquired or disposed of and if acquired or disposed of on a securities exchange, give agent's name.

FORM 6

NOTICE OF PLACE AT WHICH REGISTER IS TO BE KEPT
1.	Name:	________________
2.	Capacity in which section 86 of the Act applies:	________________
3.	Residential address and telephone number of applicant:	________________
4.	Business address and telephone number:	________________
5.	Name of employer (if any):	________________
6.	Place at which record is to be kept:	________________
7.	Date of commencement of keeping register:	________________
Dated this ______ day of _____________________
Signature_______________________________
Name_________________________________
Capacity________________________________

FORM 7

NOTICE OF CHANGE OF PLACE OF BUSINESS AND CHANGE OF PLACE AT WHICH REGISTER IS KEPT
1.	Name of licensee:
2.	Type of licence held and licence number:
3.	(a)	Former address of place of business:
	(b)	New address of place of business:
	(c)	Date of change of place of business:
4.	(a)	Former address of place at which register was kept:
	(b)	New address of place at which register is kept:
	(c)	Date of change of address of place at which register is kept:
Dated this ______ day of _____________________
Signature_______________________________
Name_________________________________
Capacity________________________________

FORM 8

NOTIFICATION OF CESSATION OF BUSINESS
1. Name of licensee:________________________________________
2. Type of licence held and licence number:____________________________
3. Notice is given that on the ____day of _____________, business ceased to be carried on in Saint Lucia by the above-mentioned licensee in respect of which he was licensed to carry on business.
Dated this ______ day of _____________________
Signature_______________________________
Name_________________________________
Capacity________________________________

FORM 9

NOTICE OF CHANGE OF REPRESENTATIVE'S EMPLOYER AND NOTICE OF CHANGE OF PLACE AT WHICH REGISTER IS KEPT
1. Name of licensee:________________________________________
2. Type of licence held and licence number:____________________________
3. Residential Address:_______________________________________
4. Notice is given that on the _____ day of __________________ the licensee will cease to be a representative of ________________ and that from the ______ day of ____________ the licensee will be a representative of ___________________ whose principal place of business is at ______________________________
5.	(a)	Former address of place at which register was kept:
	(b)	New address of place at which register is kept:
	(c)	Date of change of address of place at which register is kept:
Dated this ______ day of _____________________
Signature_______________________________
Name_________________________________
Capacity________________________________