Updated Sample Compliance Officer Form Page 3
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3APPLICATION FOR THE APPROVAL OF COMPLIANCE OFFICERS
In accordance with Section 4(2) of the Financial Obligations Regulations, 2010.
18. Do you receive performance bonuses as part of your compensation package?
YES
NO
19. Does your job involve responsibility for a broader compliance, risk related or any other
YES
NO
functional areas in your company?
If yes, please give particulars
20. As Compliance Officer, will you be reporting directly to the Board of Directors of your
YES
NO
employer?
If not, please give particulars.
21. Is there any other information that you consider relevant to this application?
YES
NO
If yes, please give particulars.
I hereby certify that the information contained in this application form and all appendices hereto attached are true
and accurate to the best of my knowledge and belief.
_______________________
________________________________
____________________________
DATE
SIGNATURE OF APPLICANT
PRINT NAME
________________________
________________________________
____________________________
DATE
SIGNATURE OF CEO
PRINT NAME
_______________________
________________________________
____________________________
DATE
SIGNATURE OF DIRECTOR
PRINT NAME
Please submit the following together with this application form:
-Certified copies of all academic certificates (Bachelor’s degree or higher)
-Certified copies of all professional qualifications or certifications
- A current Curriculum Vitae detailing your employment history
- Certified copies of two forms of identification
- Two (2) passport size photos
- Police Certificate of Character
NB.
-Details relevant to questions 1-21 can be provided on an additional sheet.
-For the purpose of this application, a ‘Certified Copy’ is a photocopy of a document that is signed and attested to as an accurate
and a complete reproduction of the original document by a Notary Public or Commissioner of Affidavits. In the alternative,
original documents together with photocopies can be brought to the Commission for certification by the Staff.
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