Updated Sample Compliance Officer Form
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3APPLICATION FOR THE APPROVAL OF COMPLIANCE OFFICERS
In accordance with Section 4(2) of the Financial Obligations Regulations, 2010.
First Name:
Middle Name:
Surname:
FOR TTSEC
OFFICIAL USE
ONLY
Country of birth:
Identification No
Passport __________________________________
National Identification________________________
Country/Countries of Citizenship:
Drivers Permit ______________________________
Other _____________________________________
Please Specify_________________________________
Date of birth: DD/MM/YYYY
Email:
Residential Address:
Contact #:
Fax:
Work:
Home:
Mobile:
Highest Level of education: Eg. Secondary, tertiary, undergraduate etc.
Mailing Address (If different from
Professional qualification or membership:
above):
Have you ever had a change of name? (If yes, please give details)
Are you known by any other name? (If yes please give details)
Name of Employer :
Annual Renewal Date of Employer’s
Registration with TTSEC:
Category of Registration(s) employer holds with TTSEC:
Is your employer registered with another regulator
YES
NO
If yes please state the name of the regulator(s) and the category of
registration(s) held with that regulator
Position held with above registered entity:
1. Have you ever been convicted of an offence in Trinidad and Tobago or elsewhere?
YES
NO
If yes, please give particulars.
2. Are there any criminal proceedings pending against you in Trinidad and Tobago or
YES
NO
elsewhere?
If yes, please give particulars
3. Have any civil or administrative fines or sanctions been imposed upon you?
YES
NO
If yes, please give particulars.
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