eLicensing:

Sample application
List of all questions that may be
asked in the AFS licence application

WARNING:
This is not an AFS licence application form.
It does not reflect the look and flow of our eLicensing online
application.

Australian Securities and Investments Commission

August 2010
What is the sample application?
This sample application incorporates all the questions that may appear in the online AFS
licence application, plus notes on how the online application works. Looking at the sample
application is particularly useful if someone else is filling out your application for you.

The online application looks different from this sample as it operates as a series of screens
that will guide you through each step.

You won't be asked all of the questions in the sample application because the eLicensing
system tailors the online application to your business. The questions you will be asked will
depend on your answers to certain initial questions, such as your entity type and the
authorisations you are applying for.

Warning
The sample application is NOT an application form and cannot be used to lodge an AFS
licence application with ASIC.

The actual online application form is available on our website at www.asic.gov.au/afsl.

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

AFS Licence Application Components:

Part A Applicant & AFS licence details
Part B AFS licensee requirements
Part C Specific questions for certain selected complex services and/or products
Part D Certifications/Declarations
Part E List of Proof documents to be attached to your application

Part A will determine what questions are asked in Parts B & C

Parts A, B, C will determine the requirements of Part D & E
Note: Once question A1 has been completed, the Name and ABN (or ACN/ARBN) will
appear as a banner at the top of each page.

Before you begin

Your Privacy
The information requested in this application is required for the granting of an Australian
financial services licence under the Corporations Act.
Some of the information collected as part of this application process will be made
available to the public.

ASIC's eLicensing service enables you to apply online for an Australian financial services
(AFS) licence.
Your AFS licence will authorise you to conduct one or a number of financial service
activities. The various activities are described in the AFS Licensing Kit (RG 1 – RG 3).
The AFS licence has different types of services and products. You may apply for one or
more of these types to be included on your licence. You must provide information and
evidence on your capacity and competence to provide the financial service activities you
are applying for. For more details see the AFS Licensing Kit.
Warning
Before commencing this application you must read and agree to the terms and conditions
set out in The ASIC Electronic Lodgement Protocol – the legal agreement that governs the
lodgement of documents electronically with ASIC.

Before you start using this service you should also be familiar with the following
information available from the Licensing homepage on our website, www.asic.gov.au/afsl:
the AFS Licensing Kit
ASIC licensing-related regulatory guides
the instructions that explain how our electronic lodgement service works.

If, after reading the above information, you still have unanswered questions, contact your
industry body for more help. You‟ll find a list of contact details at
www.asic.gov.au/fsrhelp.

You can also phone the ASIC Infoline on 1300 300 630 for help with using the eLicensing
system.

If you don't complete this online application according to the instructions your application
will not be accepted for lodgement by ASIC.

Australian Securities and Investments Commission, August 2010 Page 3 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Applying for an Australian financial services licence

Before commencing this application you must read and agree to the terms and conditions
set out in The ASIC Electronic Lodgement Protocol – the legal agreement that governs the
lodgement of documents electronically with ASIC.

Once you have started this application you can review previous questions and answers,
save, print drafts of completed questions or exit at any time. You will need your user
name, password, application number and ABN.
When you have completed this application you will need to submit it to ASIC. We will not
start to process your application until you have submitted it.
Electronic submission of this application does not constitute lodgement. Lodgement will
occur once ASIC receives the electronic submission plus required documentation – if
incomplete, your application will be rejected. A lodged application will not be assessed
until we have received the prescribed fee.
Authenticated users will be able to review and resume incomplete transactions
A0.0 I have read The ASIC Electronic Lodgement Protocol and agree to be bound by the
terms and conditions.
 Yes  No
A0.1 I have read the The ASIC Licensing Kit.
 Yes  No
A0.2 Enter the ABN, ACN or ARBN of the proposed licensee (applicant) __________
Note:
The Name and ABN/ACN/ARBN of the applicant to appear as a banner at the top of
each screen.

You must enter a user name and password to allow you access to your AFS licence
application.
A0.3 Enter a user name of your choice __________
must contain a minimum of 6
characters
Enter a password of your choice __________
must contain a minimum of 6, with
at least one numeric character, up
to a maximum of 16 characters
Confirm your password __________

Note – User name and Password are case-sensitive

A0.4 Your application reference number is XXXXXXXX

Australian Securities and Investments Commission, August 2010 Page 4 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question A1 Applicant Details

A1.1 Provide the following details for the entity applying for this AFS licence.
A1.1.1 Individual
A1.1.1.1 Date of birth
A1.1.1.2 Place of birth (City/Town, Country)

A1.1.2 Partnership
A1.1.2.1 All partners who will perform duties in connection with the
holding of this AFS licence are required to sign this
application. To tailor your declaration, indicate how many
will be signing.____________

A1.1.3 Company
Present the following message:
"You are applying for an AFS licence as a corporate entity. All details for
Directors and the Secretary will be taken from the current record in
ASIC's public database."
A1.1.4 Trustees of a trust - a collection of persons who act together as trustee of
a trust
A1.1.4.1 Is this trust a superannuation fund?
 Yes  No
If No go to A1.1.4.2.2, if Yes:
Please provide:
A1.1.4.1.1 Superannuation fund name
A1.1.4.1.2 Superannuation fund number
A1.1.4.2 All trustees who will perform duties in connection with the holding of this
AFS licence are required to sign this application. To tailor your declaration, indicate how
many will be signing. ____________

A1.1.5 Other
A1.1.5.1 To tailor your declaration, indicate how many will be signing.
____________
A1.2 Principal business address
A1.3 Address for service of notices
A1.4 Entity's website address (optional)
A1.5 In performing activities relating to this AFS licence, will you be using a registered
business name?
 Yes  No
If Yes go to A1. 5.1, if No go to A2

A1.5.1 Provide the following details. If this business name is registered in

more than one state, provide the following information in relation
to the principal state of operation only for this business name.
A1.5.1.1 Business name

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 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

A1.5.1.2 Registered business name number

A1.5.1.3 State of registration
A1.5.2 Will you be using further registered business names?
 Yes  No

Australian Securities and Investments Commission, August 2010 Page 6 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question A2 Contact Details

A2.1 Provide the following details for the person to whom we should direct all questions
and correspondence on this application.
A2.1.1 Name (First Given Name, Family Name)
A2.1.2 Are you preparing this application on behalf of the applicant as an external
service provider?
 Yes  No
If No go to A2.1.3, if Yes ask:
A2.1.2.1 Provide the service provider's name and ABN(or ACN).
A2.1.2.1.1 Name ___________________
A2.1.2.1.2 ABN(or ACN) ___________________
A2.1.3 Email address (Not Mandatory)
If email address provided:
A2.1.3.1 Email is our preferred way to contact you. Can we use this email
address to deliver correspondence and request(s) for further
information/clarification?
 Yes  No
A2.1.4 Telephone number
A2.1.5 Facsimile number (Not Mandatory)
If fax number provided:
A2.1.5.1 Can we use this fax number to deliver correspondence and
request(s) for further information/clarification?
 Yes  No
A2.1.6 Postal address
A2.1.7 DX address (not mandatory)
A2.2 Will this contact person be the ongoing contact for the AFS licence if the AFS
licence is granted?
 Yes  No
If Yes go to A3. If No ask A2.3

A2.3 Provide the following details for the ongoing authorised contact person for this AFS
licence if it is granted. All questions and correspondence about this licence will be
directed to this contact person if it is granted.
A2.3.1 Name (First Given Name, Family Name)
A2.3.2 Relationship to applicant:
A2.3.2.1 Licensee (including officers & staff) 
A2.3.2.2 External service provider 

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 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

A2.3.3 Email address (Not Mandatory)

If email address provided:
A2.3.3.1 Email is our preferred way to contact you. Can we use this email
address to deliver correspondence?
 Yes  No
A2.3.4 Telephone number
A2.3.5 Facsimile number (Not Mandatory)
If fax number provided:
A2.3.5.1 Can we use this fax number to deliver correspondence?
 Yes  No
A2.3.6 Postal address
A2.3.7 DX address (Not mandatory)

Australian Securities and Investments Commission, August 2010 Page 8 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question A3 Your Australian financial services (AFS) licence

A3.1 What type(s) of financial services would you like your AFS licence to authorise?
A3.1.1 Provide Financial Product Advice 
A3.1.2 Deal in a Financial Product 
A3.1.3 Make a Market for a Financial Product  Triggers C3
A3.1.4 Operate a Registered Scheme  Triggers C2
A3.1.5 Provide a Custodial or Depository Service  Triggers C1
A3.1.6 Provide Traditional Trustee Company Services  Triggers A4.8

A3.2 Special Services

A3.2.1 Do you wish to provide financial services as a Principal Trader only under
this licence?  Yes  No

A3.2.2 Do you wish to be subject to the condition requiring a stockbroker to assume

responsibility for the acts or omissions of a nominee company subsidiary?
 Yes  No

A3.3 The law restricts the use of certain words or expressions, or like words or
expressions, unless they are authorised in your AFS licence conditions. Do you wish
to use any of the following?
o Stockbroker or Share Broker
o Futures Broker
o Insurance Broker or Insurance Broking
o General Insurance Broker
o Life Insurance Broker
 Yes  No

Australian Securities and Investments Commission, August 2010 Page 9 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question A4 Your AFS Licence Authorisations

A4.1 Provide Financial Product Advice
A4.1.1 What type of financial product advice do you wish to be authorised for?
A4.1.1.1 Provide Financial Product Advice 
A4.1.1.2 Provide General Financial Product Advice Only 
A4.1.1.3 Provide General Financial Product Advice Only To
Wholesale Clients 
A4.1.2 What products do you wish to be authorised for?
A4.1.2.1 Deposit and Payment Products
A4.1.2.1.1 Basic Deposit Products 
A4.1.2.1.2 Non-basic Deposit Products 
A4.1.2.1.3 Non-cash Payment Products 
A4.1.2.2 Derivatives 
Or select one or more of the following
A4.1.2.2.1 Derivatives – Wool only 
A4.1.2.2.2 Derivatives – Electricity only 
A4.1.2.2.3 Derivatives – Grain only 
A4.1.2.3 Foreign Exchange Contracts 
A4.1.2.4 General Insurance
Select one of the following:
A4.1.2.4.1 General Insurance Products 
A4.1.2.4.2 General Insurance - Consumer Credit Insurance Only 
A4.1.2.5 Government Debentures, Stocks or Bonds 
A4.1.2.6 Life Products
Select from the following:
A4.1.2.6.1 Investment Life Insurance Products 
A4.1.2.6.2 Life Risk Insurance Products 
A4.1.2.6.3 Life Products - Consumer Credit Insurance Only 
Combination A4.1.2.6.2 and A4.1.2.6.3 not permitted. All
other combinations of products accepted.
A4.1.2.7 Managed Investment Schemes (registered and/or unregistered)
Select from the following
A4.1.2.7.1 Managed Investment Schemes, excluding IDPS 
A4.1.2.7.2 Managed Investments Schemes, including IDPS
A4.1.2.7.3 IDPS only 
A4.1.2.7.4 Own Managed Investment Scheme only 
A4.1.2.7.5 Horse Racing Syndicate 
A4.1.2.7.6 Timesharing Scheme 
A4.1.2.7.7 MDA Services 
A4.1.2.8 Retirement Savings Account Products 
A4.1.2.9 Securities 
A4.1.2.10 Superannuation 
A4.1.2.11Margin Lending Facility
A4.1.2.11.1 Standard Margin Lending Facility 
A4.1.2.11.2 Non- Standard Margin Lending Facility 
A4.1.2.12 Miscellaneous Financial Facility
A4.1.2.12.1 Miscellaneous Financial Investment Products 
A4.1.2.12.1.1 Miscellaneous Financial Investment
Products – MDA Services 
A4.1.2.12.2 Miscellaneous Financial Risk Products 

Australian Securities and Investments Commission, August 2010 Page 10 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Where A4.1.2.7.2 or A4.1.2.7.3 is selected present A4.1.3 – present on a new

page
A4.1.3 Do you wish to limit the Investor Directed Portfolio Service to a named
service?
 Yes  No
Yes will trigger A4.7 later in application

A4.2 Deal in a Financial Product

A4.2.1 What type of dealing activity do you wish to be authorised for?
A4.2.1.1 Deal in a financial product 
A4.2.1.2 Arrange for a person to deal in a financial product 
For whichever is selected present:
A4.2.2 What particular type(s) of dealing services do you wish to be authorised for?
A4.2.2.1 Issue, apply for , acquire, vary or dispose of a
financial product 
A4.2.2.2 Apply for, acquire, vary or dispose of financial
products on behalf of another 
A4.2.2.3 Underwriting an issue of securities or interests
in registered managed investment schemes 

Where A4.2.2.1 Issue, apply for, acquire, vary or dispose is selected:

A4.2.3 What products do you wish to be authorised for?
A4.2.3.1 Deposit and Payment Products
A4.2.3.1.1 Basic Deposit Products 
A4.2.3.1.2 Non-basic Deposit Products 
A4.2.3.1.3 Non-cash Payment Products 
A4.2.3.2 Derivatives 
Or select one or more of the following
A4.2.3.2.1 Derivatives – Wool only 
A4.2.3.2.2 Derivatives – Electricity only 
A4.2.3.2.3 Derivatives – Grain only 
A4.2.3.3 Foreign Exchange Contracts 
A4.2.3.4 General Insurance
Select one of the following:
A4.2.3.4.1 General Insurance Products 
A4.2.3.4.2 General Insurance - Consumer Credit Insurance Only 
A4.2.3.5 Government Debentures, Stocks or Bonds 
A4.2.3.6 Life Products
Select from the following:
A4.2.3.6.1 Investment Life Insurance Product 
A4.2.3.6.2 Life Risk Insurance Products 
A4.2.3.6.3 Life Products - Consumer Credit Insurance Only 
Combination A4.1.2.6.2 and A4.1.2.6.3 not permitted. All
other combinations of products accepted.
A4.2.3.7 Managed Investment Schemes (registered and/or unregistered)
Select from the following

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 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

A4.2.3.7.1 Managed Investment Schemes, excluding IDPS 

A4.2.3.7.2 Managed Investments Schemes, including IDPS
A4.2.3.7.3 IDPS only 
A4.2.3.7.4 Own Managed Investment Scheme only 
A4.2.3.7.5 Horse Racing Syndicate 
A4.2.3.7.6 Timesharing Scheme 
A4.2.3.7.7 MDA Services 
A4.2.3.8 Retirement Savings Account Products 
A4.2.3.9 Securities 
A4.2.3.10 Superannuation 
A4.2.3.11Margin Lending Facility
A4.2.3.11.1 Standard Margin Lending Facility 
A4.2.3.11.2 Non- Standard Margin Lending Facility 
A4.2.3.12 Miscellaneous Financial Facility
A4.2.3.12.1 Miscellaneous Financial Investment Products 
A4.2.3.12.1.1 Miscellaneous Financial Investment
Products – MDA Services 
A4.2.3.12.2 Miscellaneous Financial Risk Products 

Where A4.2.2.2 Apply for, acquire, vary or dispose…. on behalf of another is

selected:
A4.2.4 What products do you wish to be authorised for?
A4.2.4.1 Deposit and Payment Products
A4.2.4.1.1 Basic Deposit Products 
A4.2.4.1.2 Non-basic Deposit Products 
A4.2.4.1.3 Non-cash Payment Products 
A4.2.4.2 Derivatives 
Or select one or more of the following
A4.2.4.2.1 Derivatives – Wool only 
A4.2.4.2.2 Derivatives – Electricity only 
A4.2.4.2.3 Derivatives – Grain only 
A4.2.4.3 Foreign Exchange Contracts 
A4.2.4.4 General Insurance
Select one of the following:
A4.2.3.4.1 General Insurance Products 
A4.2.3.4.2 General Insurance - Consumer Credit Insurance Only 
A4.2.4.5 Government Debentures, Stocks or Bonds 
A4.2.4.6 Life Products
Select from the following:
A4.2.4.6.1 Investment Life Insurance Product 
A4.2.4.6.2 Life Risk Insurance Products 
A4.2.4.6.3 Life Products - Consumer Credit Insurance Only 
Combination A4.1.2.6.2 and A4.1.2.6.3 not permitted. All
other combinations of products accepted.
A4.2.4.7 Managed Investment Schemes (registered and/or unregistered)
Select from the following
A4.2.4.7.1 Managed Investment Schemes, excluding IDPS 
A4.2.4.7.2 Managed Investments Schemes, including IDPS
A4.2.4.7.3 IDPS only 
A4.2.4.7.4 Own Managed Investment Scheme only 
A4.2.4.7.5 Horse Racing Syndicate 

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 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

A4.2.4.7.6 Timesharing Scheme 

A4.2.4.7.7 MDA Services 
A4.2.4.8 Retirement Savings Account Products 
A4.2.4.9 Securities 
A4.2.4.10 Superannuation 
A4.2.4.11Margin Lending Facility
A4.2.4.11.1 Standard Margin Lending Facility 
A4.2.4.11.2 Non- Standard Margin Lending Facility 
A4.2.4.12 Miscellaneous Financial Facility
A4.2.4.12.1 Miscellaneous Financial Investment Products 
A4.1.2.12.1.1 Miscellaneous Financial Investment
Products – MDA Services 
A4.2.4.12.2 Miscellaneous Financial Risk Products 

A4.2.5 Do you wish to limit the Investor Directed Portfolio Service to a named
service?
 Yes  No
Yes to trigger A4.7 later in application
If A4.2.2.3 is selected present the following question.
A4.2.6 What underwriting activity(ies) do you wish to be authorised for?
A4.2.6.1 Managed Investment Schemes (registered or unregistered) 
A4.2.6.2 Securities 
Go to the next selected type from A3 or A4.6 if no further type selected.
If A4.1.2.4.1, A4.1.2.6.1, A4.1.2.6.2, A4.2.3.4.1, A4.2.3.6.1, A4.2.3.6.2,
A4.2.4.4.1, A4.2.4.6.1, A4.2.4.6.2 are selected present the following question.
A4.2.7 In providing the financial service relating to contracts of insurance will you
act on behalf of intending insureds?
 Yes  No
Yes to trigger B8 later in application.

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 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

A4.3 Make a Market for a Financial Product

A4.3.1 What products do you wish to be authorised to make a market in?
A4.3.1.1 Foreign Exchange Contracts 
A4.3.1. 2 Derivatives 
A4.3.1. 3 Derivatives – Wool only 
A4.3.1. 4 Derivatives – Electricity only 
A4.3.1. 5 Derivatives – Grain only 
A4.3.1. 6 Bonds and debentures 
A4.3.1. 7 Other financial products 
A.4.4 Operate a Registered Scheme
A4.4.1 How will you operate your registered managed investment scheme(s) under
your AFS licence.
A4.4.1.1 Scheme(s) of a particular asset kind(s) 
A4.4.1.2 Named scheme(s) 
If A4.4.1.1 is selected present A4.4.2. If A4.4.1.2 is selected present A4.4.2
for each scheme named in A4.4.5.
A4.4.2 What is the particular kind of scheme you currently operate or wish to
register under this AFS licence.
A4.4.2.1 Derivatives 
A4.4.2.2 Direct Real Property 
A4.4.2.3 Film Schemes 
A4.4.2.4 Financial assets 
A4.4.2.5 IDPS-like 
A4.4.2.6 Mortgages 
A4.4.2.7 Primary Production 
A4.4.2.8 Time Sharing Scheme 
If A4.4.2.2 (Direct Real Property) selected,
A4.4.3 You have selected the Direct Real Property asset type. Do you wish to limit
this asset type further?
 Yes  No
If Yes present the following:
A4.4.3.1 What particular type(s) of Direct Real Property scheme do you
wish to operate?
A4.4.3.1.1 Listed property trusts 
A4.4.3.1.2 Serviced Strata schemes 
A4.4.3.1.3 Stable property trusts or syndicates 
If A.4.4.2.7 (Primary Production) selected,
A4.4.4 What particular Primary Production scheme(s) do you wish to operate?
A4.4.4.1 Aquaculture 
A4.4.4.2 Cattle breeding 
A4.4.4.3 Forestry 
A4.4.4.4 Horse breeding 

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A4.4.4.5 Horticulture 
A4.4.4.6 Livestock grown for fleece 
A4.4.4.7 Ratites (Ostriches/Emus) 
A4.4.4.8 Tea Trees 
A4.4.4.9 Viticulture 
A4.4.4.10 Other Specialised Scheme 
If A4.4.1.2 (Named Schemes) selected,
A4.4.5 Provide the following details for all Named Schemes you wish to cover under
this AFS licence.
A4.4.5.1 Scheme name __________

A4.4.5.2 Is this scheme already registered?

 Yes  No
If Yes go to A4.4.5.2.1. If No go to A4.4.5.3.
A4.4.5.2.1 The Australian Registered Scheme Number of the
named scheme ________
Edit: Check register and present Scheme Name. If
invalid ARSN can not proceed without change.
A4.4.5.3 Do you have further named schemes under this AFS licence?
 Yes  No
A4.5 Provide a Custodial or Depository Service
A4.5.1 How will you operate this custodial or depository service? Both can be
selected.
A4.5.1.1 Investor Directed Portfolio Service (IDPS) 
A4.5.1.2 Custodial or Depository Service that is not an IDPS 
If A4.5.1.1 is selected go to A4.5.2 ask:
A4.5.2 Do you wish to limit the Investor Directed Portfolio Service to a named
service?
 Yes  No
Yes will trigger A4.7 later in application:

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 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

To be presented only where Yes has been answered to A3.3, ie elected to use
certain words/expressions.
A4.6 Authorisation to use certain words or expressions
A4.6.1 You have indicated that you wish to use one or more of the following or like
words or expressions. Which word(s) or expression(s), or like word(s) or
expression(s) do you wish to use?
A4.6.1.1 Stockbroker or Sharebroker 
A4.6.1.2 Futures Broker 
A4.6.1.3 Insurance Broker or Insurance Broking 
A4.6.1.4 General Insurance Broker 
A4.6.1.5 Life Insurance Broker 
If Yes to A4.6.1.1
A4.6.2 Will you be a member participant in a market that holds an Australian
markets licence that covers dealings in securities?
 Yes  No
If Yes to A4.6.1.2
A4.6.3 Will you be a member participant in a market that holds an Australian
markets licence that covers dealings in derivatives?
 Yes  No
If Yes to A4.6.1.3
A4.6.4 In providing the financial service relating to contracts of insurance will you
act on behalf of intending insureds?
 Yes  No
A4.6.4 is a trigger for B8
If Yes to A4.6.1.4
A4.6.5 In providing the financial service relating to contracts of general insurance
will you act on behalf of intending insureds?
 Yes  No
A4.6.5 is a trigger for B8
If Yes to A4.6.1.5
A4.6.6 In providing the financial service relating to contracts of life insurance will
you act on behalf of intending insureds?
 Yes  No
A4.6.6 is a trigger for B8

Present this question only if Yes answered to A4.1.3 or A4.2.5 or A4.5.2

A4.7 Provide the name of this service. More than one may be provided.

Australian Securities and Investments Commission, August 2010 Page 16 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

A4.8 Are you prescribed by the Corporations Regulations as a trustee company for the
purpose of the Corporations Act ?
 Yes  No
If no, the following error message should appear:
“You must be prescribed by the Corporations Regulations as a trustee company to
be authorised to provide Traditional Trustee Company Services. Please contact
Treasury for more information on how to be prescribed as a trustee company.”

Australian Securities and Investments Commission, August 2010 Page 17 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question A5 Business Description

A5.1 What type of client group(s) will your current or intended business service?
A5.1.1 Retail clients 
A5.1.2 Wholesale clients 
A5.2 Provide the following details on how you will transact with clients under your AFS
licence.
A5.2.1 Are you likely to have financial obligations to clients of $100,000 or more (in
total) from transacting with them?
 Yes  No
A5.2.2 Will your only liabilities to clients be under debentures you issue under
Chapter 2L of the Corporations Act?
 Yes  No
A5.2.3 Are you likely to hold client monies including premiums, contributions and
investment monies?
 Yes  No
A5.2.3.1 Will you be holding these amounts in a trust account?
 Yes  No

A5.2.3.2 Are you likely to hold $100,000 or more of client monies and/or
property at any time under this AFS licence?
 Yes  No
A5.2.4 Will you be operating an IDPS under this AFS licence?
 Yes  No
A5.2.4 is a trigger for B8
A5.3 Are you, or have you applied to be, a body regulated by the Australian Prudential
Regulation Authority (APRA)?
 Yes  No
If Yes go to A5.4, if No:
A5.3.1 Are you a wholly owned subsidiary (either directly or indirectly) of a body
regulated by APRA?
 Yes  No
A5.4 Will you be acting as a general insurance underwriting agent or a general insurance
broker acting under binders under this AFS licence ?
 Yes  No

Australian Securities and Investments Commission, August 2010 Page 18 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

A5.5 What activities best describe your intended business under this AFS licence? You
may select up to 4. Please mark your selections in numerical order proportionate
to your business activities.
A5.5.1 Actuary A5.5.25 Investment Company
A5.5.2 Accountant A5.5.26 Life Insurance Agent (single
A5.5.3 Adviser insurer)
A5.5.4 Approved Trustee A5.5.27 Life Insurance Multi Agent
A5.5.5 Asset Consultant A5.5.28 Managing general underwriter
A5.5.6 Bank A5.5.29 Margin lender
A5.5.7 Building Society A5.5.30Mortgage Broker
A5.5.8 Call Centre A5.5.31 Non-Public Offer Superannuation
A5.5.9 Conglomerate Fund Trustee
A5.5.10 Custodian or Depository Service A5.5.32 Payment Product Provider
A5.5.11 Credit Union A5.5.33 Product Issuer
A5.5.12 Derivatives dealer A5.5.34 Real Estate Agent
A5.5.13 Exempt Stockmarket A5.5.35 Registered General Insurance
A5.5.14 Experts Reports / Research Broker
House A5.5.36 Registered General Insurance
A5.5.15 Finance Broker Company
A5.5.16 Financial Planner A5.5.37 Registered Independent Options
A5.5.17 Foreign Exchange Dealer Trader
A5.5.18 Friendly Society A5.5.38 Registered Life Insurance Broker
A5.5.19 Futures Adviser A5.5.39 Registered Life Insurance
A5.5.20 Futures Broker Company
A5.5.21 General Insurance Agent (single A5.5.40 Responsible Entity
insurer) A5.5.41 Securities Dealer
A5.5.22 General Insurance Multi Agent A5.5.42 Solicitor/Legal Adviser
A5.5.23 General Insurance Underwriting
Agency A5.5.43 Stockbroker/Sharebroker
A5.5.24 Investor Directed Portfolio A5.5.44 Superannuation Service
Service Operator Provider
A5.5.45 Telephone Sales

Australian Securities and Investments Commission, August 2010 Page 19 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

A5.6 What best describes the size of the applicant in each of the following categories.
A5.6.1 Net assets (including related body corporates that provide financial services)
at the end of the last financial year.
A5.6.1.1 Less than $5 million 
A5.6.1.2 $5 million to $20 million 
A5.6.1.3 Greater than $20 million 
A5.6.2 Gross revenue (including related body corporates that provide financial
services) in the last financial year.
A5.6.2.1 Less than $5 million 
A5.6.2.2 $5 million to $50 million 
A5.6.2.3 Greater than $50 million 
A5.6.3 Current employees (including related body corporates that provide financial
services).
A5.6.3.1 Less than 20 
A5.6.3.2 20 to 100 
A5.6.3.3 Greater than 100 

A5.7 Will you be providing financial services under this licence in your capacity as a
trustee of a trading trust?
 Yes  No
A5.8 In what month does your financial year end?

Australian Securities and Investments Commission, February 2010 Page 20 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question B1 Organisational Competence - Responsible Managers

To obtain an AFS licence you must show that you have one or more responsible managers
with the necessary competence to provide the services under your AFS licence: see ASIC's
Regulatory Guide 105 Licensing: Organisational competence (RG 105). A responsible
manager must be a natural person.
If you wish to nominate more than one responsible manager, the details of each person
must be entered separately.

Provide the following details for your responsible manager(s).

B1.1 Full name (First Given, Other Given, Family Name)
B1.2 Birth details (DOB, City/Town, Country)
B1.3 What is the relationship of this person to the entity that will hold this AFS licence?
B1.3.1 an employee/officer 
B1.3.2 owner/partner 
B1.3.3 an external service provider 
B1.4 What best describes this person's role for your organisation?
 Accountant  Financial Controller
 Asset Specialist  General Manager
 Chief Executive Officer  Human Resource Manager
 Chief Investment Officer  Legal Adviser
 Company Secretary  Marketing Manager
 Compliance Manager  Operations Manager
 Compliance Officer  Partner/Proprietor
 Director  Professional Adviser
 Distribution Manager  Trustee
B1.5 What financial services will this person be a responsible manager for?
Present their selections from A3.2 and allow them to tick one or more
B1.5.1 On average, how many days will this person spend on duties related to the
provision of financial services by the applicant or its related body corporate?
 Less than 1 day per month
 Less than 1 day per week
 1 to 3 days per week
 More than 3 days per week

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 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

B1.6 What industry category(ies) best describes this person's area of experience?
 Accounting  Law Firm/Legal
 Asset Specialist  Life Insurance
 Banking or like services  Management
 Custodial / Depository  Margin Lending
 Derivatives  Securities Dealing
 Financial/Investment  Stockbroking
Advising  Superannuation
 Foreign Exchange  Technical Adviser
 Funds Management  Underwriting
 General Insurance
B1.7 What best describes the overall type of experience they have?
 Management – small entity
 Management – medium to large entity
 Technical adviser
 Employee/representative – small entity
 Employee/representative – medium to large entity
B1.8 Which of the following best describes the length of their relevant industry
experience?
 at least 3 years experience in the last 5 years
 at least 5 years experience in the last 8 years
 none of the above
B1.8.1 Where was this experience predominantly obtained?
Present drop down box of countries
B1.9 Which of the five options for demonstrating knowledge and skills do they meet?
Note: The five options are explained in Section C of RG 105.
 1. Meets widely adopted and relevant industry standard, or relevant
standard set by APRA; or
 2. Has been individually assessed by an authorised assessor as having
relevant knowledge equivalent to a diploma; or
 3. Holds a university degree in a relevant discipline and has completed a
relevant short industry course; or
 4. Holds a relevant industry- or product-specific qualification equivalent to
a diploma or higher; or
 5. Other demonstration of knowledge and skills
B1.10 Do you have further responsible managers?
 Yes  No
If Yes, recommence at Question B1.1, allow a maximum of 20.

Australian Securities and Investments Commission, February 2010 Page 22 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question B2 Organisational Competence - Processes

To obtain an AFS licence you must show that you have process(es) for ensuring that you
and your responsible managers maintain the relevant competence to continue to carry
out their duties under the AFS licence efficiently, honestly and fairly.
B2.1 Do you use a documented process to ensure that all responsible managers meet
the training and experience requirements of ASIC's RG 105?
 Yes  No
B2.2 Do you use a documented process to ensure that all responsible managers are of
good fame and character?
 Yes  No
B2.3 Do you use a documented review process to ensure that you will maintain the
organisational competence to carry out your obligations under the AFS licence?
 Yes  No
B2.3.1 At a minimum, how often will you undertake this review?
 Monthly  Annually
 Quarterly  Less than once a year
 Half Yearly
B2.4 Do you use a documented process to ensure that your responsible managers
maintain and update their competence?
 Yes  No
B2.5 Do you use a documented process to ensure compliance with all relevant industry
codes and/or standards?
 Yes  No
If No go to B3, If Yes:
B2.5.1 Has a relevant independent third party assessed that you are
satisfactorily complying with these codes and/or standards in the last two
years?
 Yes  No

Australian Securities and Investments Commission, February 2010 Page 23 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question B3 Compliance Arrangements

To obtain an AFS licence you must show that you have processes in place to adequately
monitor compliance with your AFS licence conditions and the law: see ASIC's Regulatory
Guide 104 Licensing: Meeting the general obligations (RG 104).
These may be specific to the entity applying for the licence or may cover a corporate
group.
B3.1 Have you established compliance and reporting arrangements for your AFS
licence activities?
 Yes  No
If No go to B3.2, if Yes:
B3.1.1 Are your compliance arrangements documented (either on an entity or
group basis)?
 Yes  No
B3.1.2 Do your compliance arrangements specify how often compliance with
procedures is monitored and reported on?
 Yes  No
B3.1.3 Do you use a documented process to maintain the adequacy of your
compliance and monitoring arrangements?
 Yes  No
If No go to B3.1.4, if Yes:
B3.1.3.1 How often will you review your compliance and monitoring
arrangements?
 Annually
 Monthly
 Less than once
 Quarterly
a year
 Half yearly

B3.1.4 Will your compliance arrangements be subject to external

audit/review?
 Yes  No
If No go to B3.1.5, if Yes:
B3.1.4.1 What term best describes who will be conducting these
external reviews?
 external auditor
 industry body
 service provider
B3.1.4.2 How often will these audits/reviews be conducted?
 Monthly  Annually
 Quarterly  Less than once
 Half yearly a year

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 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

B3.1.5 Is there a person(s)responsible for ongoing reporting in relation to your

levels of compliance and for ensuring the adequacy of your compliance
arrangements?
 Yes  No
If No go to B3.1.6 If Yes;
B3.1.5.1 Does this person(s) have direct access to your governing body?
 Yes  No
B3.1.6 Are your compliance arrangements generally consistent with the Australian
Standard on Compliance Programs AS 3806-2006?
 Yes  No
B3.1.7 Are your compliance arrangements generally consistent with another
external standard, eg international or industry standards?
 Yes  No
B3.1.8 Have you made arrangements with issuers of margin lending facilities and
retail clients to receive notifications of margin calls on behalf of retail
clients?
 Yes  No
If Yes,
B3.1.8.1 Do you use a documented process to ensure that reasonable steps
are taken to notify clients when a margin call occurs?
 Yes  No
B3.2 Will any substantial activities under this AFS licence be outsourced?
 Yes  No
If No go to B3.3, if Yes:
B3.2.1 Who will these activities will be outsourced to?
B3.2.1.1 Related party or parties 
B3.2.1.2 Independent/external party or parties 
B3.2.1.3 Both related and independent/external parties 
B3.2.2 Are any of these parties located outside of Australia?
 Yes  No
B3.2.3 What function(s) will be outsourced?
 All functions  Computing/Information
 Accounting Technology
 Administration  Credit Assessment
 Asset management  Custody
 Asset selection  Distribution
 Call centre  General management
 Compliance monitoring  Human resource
and supervision management

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 Investment  Training
management  Transactional functions
 Legal  Unit pricing
 Marketing  Verification of retail
 Product development client information
 Research
 Risk Management
B3.2.4 Do you have a process in place to ensure that providers selected for any
outsourced functions are suitable?
 Yes  No
B3.2.5 Will these service providers be under a formal written contract to your
organisation?
 Yes  No
B3.2.6 What business process(es) describe how you will monitor these outsourced
functions?
 Regular inspection
 Management reporting
 Assessment against contractual obligations
B3.2.6.1 At a minimum, what will be the frequency of these processes?
 Weekly
 Monthly
 Quarterly
 Half Yearly
 Annually
 Less than once a year
B3.2.7 Does your process effectively monitor and address any issues with service
standards that may lead to breaches of your AFS licence conditions?
 Yes  No
B3.3 Have you appointed an ASIC registered auditor(s) or a firm of auditors?
 Yes  No
If Yes go to B3.3.1
B3.3.1 Provide the following details for each auditor or firm of auditors that you
have appointed.
B3.3.1.1 Date of appointment
B3.3.1.2 You have appointed:
B3.3.1.2.1 an ASIC registered auditor 
B3.3.1.2.2 a firm of auditors 
B3.3.1.3 Provide the following details.
B3.3.1.3.1 ASIC registered auditor number
B3.3.1.3.2 Full name (First given & family name or firm name)
B3.3.1.4 Provide the following details.
B3.3.1.4.1 ABN
B3.3.1.4.2 Principal business address

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 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

B3.3.2 Have you appointed further auditors?

 Yes  No
If Yes loop back to B3.3.1, allow for 20. If No B3 ends.

Australian Securities and Investments Commission, February 2010 Page 27 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question B4 Representatives
To obtain an AFS licence you must show that you have adequate arrangements to:
comply with the law and AFS licence conditions
supervise and monitor the activities of your representatives and ensure that any
breaches are identified and remedied
ensure that your representatives are adequately trained and competent, including those
that are required to comply with ASIC's Regulatory Guide 146 Licensing: Training of
financial product advisers (RG 146) comply and continue to do so
B4.1 Provide the following details for your representatives.
Only present questions B4.1.1 and B4.1.2 if 'Retail' at A5.1 and Advise at A3.2.1 are
selected
B4.1.1 Do your representatives who provide financial product advice to retail
clients meet the requirements of RG 146?
 Yes  No
B4.1.2 Do you have an ongoing process to ensure that all new representatives you
appoint will comply with the requirements of RG 146 before giving retail
financial advice?
 Yes  No
B4.1.3 Do you use documented training programs, including continuing education,
for your representatives?
 Yes  No
B4.1.4 Do you maintain records of training programs attended by your
representatives?
 Yes  No
B4.1.5 Do you have documented processes to supervise and monitor your
representatives to ensure they comply with their obligations under the law?
 Yes  No
B4.1.6 Do you use a documented process to ensure that all representatives are
trained, competent and will provide financial services on your behalf
efficiently, honestly and fairly?
 Yes  No
B4.2 Provide the following details for the authorised representatives to be appointed
under this AFS licence.
B4.2.1 Will you be appointing authorised representatives under this AFS licence if it
is granted?
 Yes  No
If No go to B4.3, if Yes go to Question B4.2.1.1:
B4.2.1.1 Approximately how many authorised representatives will be
appointed under this licence within the first 12 months, if it is
granted? _____________
B4.2.1.2 Where will your authorised representatives be located?

Australian Securities and Investments Commission, February 2010 Page 28 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

 Australia Wide
 ACT
 NSW
 NT
 QLD
 SA
 TAS
 VIC
 WA
 Overseas
B4.2.1.3 Do you have a documented process to ensure that your authorised
representatives do not act outside the scope of their
authorisations?
 Yes  No
B4.2.1.4 Do you have a documented process to ensure that changes about
your authorised representatives are notified to ASIC within 15
business days?
 Yes  No
B4.3 Do you have a process to ensure that those people who are providing retail financial
advice or directly handling client monies under your AFS licence have not engaged
in misconduct previously.
 Yes  No
If Yes go to B4.3.1, if No go to B5
B4.3.1 Which of the following are included in this process?
 Police check
 ASIC register check
 Credit/bankruptcy check
 Independent reference check
 Personal good fame and character declaration
 Conflict of interest declaration
 Employment contract
 None of the above

Australian Securities and Investments Commission, February 2010 Page 29 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question B5 Adequacy of Resources

This question is to be presented to entities who are not APRA regulated, ie present
only where NO to A5.3.
To obtain an AFS licence you must show that you have, or have access to, sufficient
financial, human and information technology resources to properly carry out your
responsibilities under your AFS licence and the law.
B5.1 Provide the following details about your financial resources.
B5.1.1 Do you have documented processes to ensure you meet the requirements of
ASIC's Regulatory Guide 166 Licensing: Financial requirements (RG 166)?
 Yes  No
B5.1.2 Do your compliance arrangements outline how you will comply with your
financial requirement obligations?
 Yes  No
B5.1.3 Do your compliance arrangements outline how you will monitor and report
on your compliance with these obligations?
 Yes  No

B5.2 Provide the following information about your human resources and organisational
structure.
B5.2.1 How many full time equivalent employees and contractors will undertake
AFS licence related functions.
________
B5.2.2 Do you use a documented process to ensure that, at all times, you have an
adequate number of trained and competent staff to provide the financial
services covered by this licence?
 Yes  No
B5.2.3 Do you use a documented process to adequately monitor and supervise your
staff?
 Yes  No

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 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

B5.3 Provide the following information about your information technology resources.
B5.3.1 Do you have IT systems to support your business processes?
 Yes  No
If No B5.3 ends. If Yes:
B5.3.1.1 What process best describes how you undertake your IT
development?
 In house
 Contracted supplier
 As needs basis with a related party
 As needs basis with an unrelated party
B5.3.1.2 What process best describes how you undertake your IT support?
 In house IT support
 Contracted supplier
 As needs basis with a related party
 As needs basis with an unrelated party
B5.3.1.3 Do you have old/existing systems that you will need to integrate
with those IT systems you will use to manage your AFS licence?
 Yes  No
If No go to B5.3.1.4, if Yes:
B5.3.1.3.1 Will this require manual workarounds to enable you to
comply with your reporting and business
requirements?
 Yes  No
B5.3.1.4 Do you have a documented disaster recovery plan in the event of
loss of data or failure of computer hardware?
 Yes  No
If No go to B5.3.1.5, if Yes
B5.3.1.4.1 At a minimum, how often will you test your disaster
recovery plan?
 Weekly
 Monthly
 Quarterly
 Half Yearly
 Annually
 Less than once a year

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 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

B5.3.1.5 At a minimum, how often will you backup your IT information?

 Continuously
 Daily
 Weekly
 Monthly
 Less often than Monthly
 Never
B5.3.1.6 At a minimum, how often will you store IT backups offsite?
 Continuously
 Daily
 Weekly
 Monthly
 Less often than Monthly
 Never
B5.3.1.7 What process(es) best describes how you will ensure your
computer system is adequate?
 Review response time
 Measure down times
 User survey
 Compare to standards/benchmarks
 External review
 None

Australian Securities and Investments Commission, February 2010 Page 32 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question B6 Dispute Resolution

To be presented to retail applicants, ie where A5.1.1 has been selected.
To obtain an AFS licence you must show that you have a dispute resolution system in place
that comprises:
internal dispute resolution procedures that meet the Essential Elements of the
Australian Standard on Complaints Handling AS 4269-1995 and other minimum
requirements set out in ASIC's Regulatory Guide 165 Licensing: Internal and external
dispute resolution (RG 165); and
membership of one or more ASIC approved external dispute resolution scheme(s) that
can deal with complaints about all of the financial services you provide to retail
clients under your AFS licence
B6.1 Do you have an internal dispute resolution procedure in place?
 Yes  No
If No, go to B6.2, if Yes:
B6.1.1 What best describes the role of the person in your organisation with
responsibility for internal dispute resolution.
 Chief Executive Officer  Director
 Complaints Manager  General Manager
 Compliance Manager  Operations Manager
 Compliance Officer  Partner/Proprietor
 Customer Services
Manager
B6.1.2 Does your internal dispute resolution procedure meet the Essential Elements
of AS 4269-1995 and the minimum requirements of ASIC's RG 165 ?
 Yes  No
B6.1.3 Is this procedure documented?
 Yes  No
B6.1.4 Is a guide to this procedure, or a document setting out this procedure,
available for retail clients?
 Yes  No
B6.1.5 Does the procedure contain a requirement for unresolved complaints to be
referred to a relevant external dispute resolution scheme?
 Yes  No
B6.2 Are you a member of one or more external dispute resolution schemes?
 Yes  No
Please note that you must be a member of an external dispute resolution scheme before
submitting your AFS licence application.
If No go to B6 ends, if Yes:
B6.2.1 What best describes the role of the person in your organisation with
responsibility for external dispute resolution.
 Chief Executive Officer  Customer Services
 Complaints Manager Manager
 Compliance Manager  Director
 Compliance Officer  General Manager

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 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

 Operations Manager  Partner/Proprietor

B6.2.2 Provide the following details for the external dispute resolution schemes
that cover some or all of the financial services you will provide under this
AFS licence.
B6.2.2.1 Coverage.
B6.2.2.1.1 All services covered 
B6.2.2.1.2 Some services covered 
B6.2.2.2 Scheme details
B6.2.2.2.1 Financial Industry Complaints Service* 
B6.2.2.2.2 Credit Ombudsman Service Ltd 
B6.2.2.2.3 Banking and Financial Services 
Ombudsman (formerly Australian Banking
Industry Ombudsman)
B6.2.2.2.4 Superannuation Complaints Tribunal 
B6.2.2.2.5 Credit Union Dispute Resolution Centre 
B6.2.2.2.6 Insurance Brokers Dispute Ltd 
B6.2.2.2.7 Financial Co-Operative Dispute 
Resolution Scheme
B6.2.2.2.8 Insurance Ombudsman Service Ltd 
B6.2.2.2.9 Financial Ombudsman Service 
B6.2.2.2.10 Other, please specify 

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 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question B7 Risk Management

This question is to be presented to entities who are not APRA regulated, ie present
only where NO to A5.3.
To obtain an AFS licence you must show that you have an adequate risk management
system.
B7.1 Provide the following details of your risk management process (see ASIC's RG 104).
B7.1.1 Does it include the process for the identification, analysis, evaluation,
treatment and communication of the risks associated with your business?
 Yes  No
B7.1.2 Does it provide for monitoring and reporting risk management issues?
 Yes  No
B7.1.3 Is it generally consistent with the Australian Standard on Risk Management
Systems AS/NZS 4360:2004?
 Yes  No
B7.1.4 Is it documented?
 Yes  No
B7.2 Have you assessed the risks associated with your business and established the
probability of these risks occurring?
 Yes  No
B7.3 Have you prioritised your business risks?
 Yes  No
B7.4 Have you established which risks need to be addressed and managed?
 Yes  No
B7.5 Will you use a process to educate your relevant staff on risk management?
 Yes  No
B7.6 Will your risk management system be subject to audit/review?
 Yes  No
If No B7 ends, if Yes:
B7.6.1 What best describes who will conduct these audits/reviews.
 internal staff  industry body
 external auditor  service provider
B7.6.2 At a minimum, how often will these audits/reviews be conducted?
 Monthly  Annually
 Quarterly  Less than once a
 Half yearly year

Australian Securities and Investments Commission, February 2010 Page 35 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question B8 Compensation and Insurance Arrangements

To be presented to retail applicants (A5.1.1 selected), or yes to operate a registered
scheme (Yes to A3.1.4), or Yes to operate an IDPS (Yes to A5.2.4)

B8.1 Are you required to have adequate professional indemnity insurance for your AFS
licence activities?
 Yes  No

If Yes, go to B8.1.1 If No go to B8.2

B8.1.1 Do you already have professional indemnity insurance that complies with
ASIC's policy on compensation and insurance arrangements for AFS licensees?
 Yes  No

If Yes, the remaining questions do not apply

B8.1.2 Do you have a process to ensure that you will have professional indemnity
insurance that complies with ASIC's policy on compensation and insurance
arrangements for AFS licensees in place when your AFS licence takes effect?
 Yes  No

If 'yes' at question B8.1 the following questions do not apply. Allow only 1 option from
B8.2.1 to B8.2.5 to be selected
B8.2 Why are you not required to have adequate professional indemnity insurance for
your AFS licence activities?
B8.2.1 General insurance company 
B8.2.2 Life insurance company 
B8.2.3 Authorised deposit taking institution 
B8.2.4 ASIC approved guarantee from a related company or institution 
B8.2.5 ASIC approved alternative arrangements 
If B8.2.4 or B8.2.5 selected, present the following message:
"In order to obtain ASIC's approval of a guarantee provided by a related company or
institution that is a general insurance company, a life insurance company or an
authorised deposit taking institution, or ASIC's approval of an alternative
compensation arrangement, you will be required to apply in writing. Refer to Part
2 of the ASIC Licensing Kit (RG 2) on ASIC's website for guidance."
B8.2.4.1 Has ASIC's approval been obtained?
 Yes  No

Australian Securities and Investments Commission, February 2010 Page 36 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question B9 Research and Benefits

Present if Advising is selected (ie A3.1.1) and retail is selected (A5.1.1).
B9.1 Provide the following details on the product and market research you will conduct.
B9.1.1 What process(es) best describes how you will select the products you intend
to advise on?
 own product only  review product
issuer service
 own assessment of standards
services/products
 external research
 review product house(s)
issuer ratings
B9.1.2 How often will this process be reviewed?
 Daily  Less often than
 Weekly monthly
 Monthly
B9.1.3 Do you have a recommended list of financial products?
 Yes  No
If No go to B9.2, if Yes:
B9.1.3.1 At a minimum, how often will this list be reviewed?
 Weekly  Half Yearly
 Monthly  Yearly
 Quarterly
B9.1.3.2 How many products are on your recommended list?
 Less than 10  50 to 100
 10 to 20  more than 100
 20 to 50
B9.2 Which remuneration or other benefits do your representatives receive in
relation to the financial product advice that they provide? This includes
remuneration or benefits they receive from you and from third party product
providers.
 back office payments  profit share arrangements
 commission  salary
 equitable interest in  volume bonus (linked to
product being sold the numbers or value of
 equitable interest in products sold)
product provider  other – non-salary benefits

Australian Securities and Investments Commission, February 2010 Page 37 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question C1 Custodial or Depository Service

Present only where A3.1.5 has been selected.
You wish to be authorised to provide Custodial or Depository Services. You must show that
you have the capacity to manage the current and future operational demands of these
services.
C1.1 Do you use a documented process for maintaining adequate records to ensure that
you as the licensee can immediately determine the identity and status of
investments held?
 Yes  No
C1.2 Do you use a documented process to manage access to, security of and reporting on
client accounts?
 Yes  No
C1.3 Do you use a documented process to ensure that your valuation and pricing
mechanisms for client accounts, and the subsequent information provided to
clients, is accurate?
 Yes  No
C1.4 Do you use a documented process to monitor that instructions received in relation
to client transactions are properly authorised before being executed?
 Yes  No
If the applicant has selected A4.5.1.1, ie have selected IDPS in Part A, present
questions C1.5 to C1.8. If A4.5.1.1 was not selected go to C1.9.
C1.5 Do you have other IDPS operators who will be contracting with the client to operate
the service?
 Yes  No
If Yes go to C1.5.1. If No go to C1.6
C1.5.1 Do you use documented processes to monitor the activities of the other IDPS
operators?
 Yes  No
C1.5.2 Do you have written agreements with the other IDPS operators who will be
providing the service to the clients?
 Yes  No
C1.6 Will you provide clients of the service with continuous electronic daily access to
information on their transactions?
 Yes  No
C1.7 Will you undertake the transactional functions for the service you wish to operate?
 Yes  No
If Yes go to C1.8, if No:
C1.7.1 Will you appoint a third party with the required NTA, to provide the
transactional functions for the service you wish to operate?
 Yes  No

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 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

If Yes go to C1.7.1.1.
C1.7.1.1 Do you use documented processes to monitor the activities of the
third party who will be providing the transactional function for the
service you wish to operate?
 Yes  No
C1.7.1.2 Do you have written agreements with third parties providing the
transactional function for the service you wish to operate?
 Yes  No
C1.7.1.3 Have service standards been established and agreed?
 Yes  No
C1.8 Will you provide the custodial functions for the service you wish to operate?
 Yes  No
If Yes go to C1.9, if No:
C1.8.1 Do you have a documented process to monitor the activities of the third
party who will be providing the custodial function for the service you wish to
operate
 Yes  No
C1.8.2 Do you have written agreements with the third parties providing the
custodial services for the service you wish to operate?
 Yes  No
C1.8.3 Have service standards been established and agreed?
 Yes  No
C1.9 Will you be acting as an external MDA custodian that directly contracts with retail
clients?
 Yes  No
If C1.9 is 'Yes' then go to C1.9.1, if 'No' C1 ends
C1.9.1 Do you use a documented process to ensure that clients assets are managed
as a discrete portfolio?
 Yes  No
C1.9.2 Do you have a documented process to your ensure that your Financial
Services Guide (FSG) clearly sets out the division of responsibility between
the external MDA custodian and the MDA operator for the MDA service?
 Yes  No

Australian Securities and Investments Commission, February 2010 Page 39 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question C2 Operate a Registered Managed Investments Scheme

Present only where A3.1.4 has been selected.
To be authorised to operate a managed investment scheme(s) you must be a responsible
entity able to show that you have the capacity to deal with current and future operational
demands of the managed investment scheme(s) you will operate.
C2.1 Do you use a documented process for ensuring that all disclosure documents and
other marketing material are subjected to due diligence?
 Yes  No
C2.2 Do you use a documented process for ensuring the member registry details are
accurate and secure?
 Yes  No
C2.3 Do you use a documented process for managing settlements, corporate actions,
authorisation of transactions and investment limits?
 Yes  No
C2.4 Will you be contracting your services as a responsible entity to other organisations?
 Yes  No
C2.5 Will you be operating mortgage schemes?
 Yes  No
If No go to C2.6 if Yes
C2.5.1 Please indicate what types of mortgage schemes you will be operating
C2.5.1.1 Unit Trusts 
C2.5.1.2 Pooled Mortgages 
C2.5.1.3 Contributory Mortgages – general authority 
C2.5.1.4 Contributory Mortgages – specific authority 
C2.5.1.5 Direct Mortgages 
Edit: this needs to be completed if A4.4.2.6 is selected
C2.6 Will you have a compliance committee?
 Yes  No
If No go to C2.7 if Yes:
C2.6.1 At a minimum, how regularly will the compliance committee meet?
 Weekly  Annually
 Monthly  Less than once a
year
 Quarterly
 Half Yearly
C2.7 Will you hold scheme property for the schemes you wish to operate?
 Yes  No
If No go to C2.7.2. If Yes go to C2.7.1.
C2.7.1 Will you have and maintain the net tangible assets (NTA) required to hold
scheme(s) property?

Australian Securities and Investments Commission, February 2010 Page 40 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

 Yes  No
If Yes C2 ends.
C2.7.2 Have you appointed a third party custodian with the required minimum NTA
to hold this scheme property?
 Yes  No

Australian Securities and Investments Commission, February 2010 Page 41 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question C3 Make a Market

Present only where A3.1.3 has been selected.
To be authorised to make a market you must be able to show that you have the capacity to
adequately manage this particular activity.
C3.1 Will any of your market making activities be on an Australian licensed market?
 Yes  No
If yes, go to C3.1.1 .If no go to C3.2
C3.1.1 Which market(s) will you make a market on?
ASX  Newcastle 
ASX Futures  SFE 
Bendigo 
C3.1.2 What best describes the proportion of your market making activities that are
conducted on an Australian licensed market
C3.1.2.1 some 
C3.1.2.2 most 
C3.1.2.3 all 
If C3.1.2.3 then remaining questions do not apply, Otherwise go to C3.2

C3.2 Have you established position limits for:

C3.2.1 Individual traders?  Yes  No
C3.2.2 Individual financial products?  Yes  No
C3.2.3 Individual counterparties?  Yes  No
C3.3 Do you have adequate arrangements for monitoring and managing settlement risk?
 Yes  No
C3.4 Is the establishment, monitoring and control of position limits and the monitoring
and control of settlement risk separate from the dealing function?
 Yes  No
C3.5 Are you currently carrying on an exempt futures market under a ministerial
declaration?
 Yes  No

Australian Securities and Investments Commission, February 2010 Page 42 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question C4 Derivatives
Present only where one of the following has been selected A4.2.3.2, A4.2.3.2.1 to
A4.2.3.2.3, A4.2.4.2, A4.2.4.2.1 to A4.2.4.2.3, A4.3.1.2 to A4.3.1. 5, A4.4.2.1
To be authorised to deal or make a market in derivatives you must show that you have
processes and systems to adequately manage this particular product.
C4.1 Will any of your derivatives activities be on an Australian licensed market?
 Yes  No
If yes, go to C4.1.1 .If no got to C4.2
C4.1.1 Which market(s) will you deal or make a market on?
ASX 
ASX Futures 
SFE 
C4.1.2 What best describes the proportion of your derivatives activities that are
conducted on an Australian licensed market
C4.1.2.1 some 
C4.1.2.2 most 
C4.1.2.3 all 
If C4.1.2.3 then remaining questions do not apply, Otherwise go to C4.2

C4.2 Do you have a designated person responsible for managing derivative legal matters
such as contracts?
 Yes  No
C4.3 Do you use documented systems and procedures to select when and how derivatives
will be traded?
 Yes  No
C4.4 Do you use documented controls, including the assessment of credit risk, to ensure
that counterparties are able to perform contractual obligations?
 Yes  No
C4.5 Will you have systems to record all derivative transactions including:
C4.5.1 reconciliation of positions  Yes  No
C4.5.2 mark to market valuation  Yes  No
C4.5.3 scenario testing  Yes  No
C4.5.4 stress testing  Yes  No
C4.6 Do you use documented processes for ensuring that valuations of, and exposure to,
derivatives are done in a timely and independent manner in accordance with
valuation standards, accounting standards and the Corporations Act?
 Yes  No
C4.7 Do you use documented processes for ensuring compliance with dealing and/or
exposure limits?
 Yes  No

Australian Securities and Investments Commission, February 2010 Page 43 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Present C4.8 only if ‘retail clients’ is selected at A5.1.1

C4.8 Do you have processes to review marketing material and disclosure documents to
ensure appropriate risk disclosures are made?
 Yes  No

Australian Securities and Investments Commission, February 2010 Page 44 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question C5 Foreign Exchange Contracts

Present only where one of the following has been selected A4.2.3.3, A4.2.4.3, A4.3.1.
1
To be authorised to deal and/or make a market in foreign exchange you must show that
you have processes and systems to adequately manage this particular product/service.
C5.1 Will you be entering foreign exchange contracts (including foreign exchange
contracts that are derivatives) as principal with a person that is not an ADI,
authorised dealer under the Banking (Foreign Exchange) Regulations or the holder
of an AFS licence that includes a condition requiring the licensee to have $10million
of tier one capital?
 Yes  No
C5.2 Do you have a qualified and experienced person responsible for managing foreign
exchange legal matters such as contracts?
 Yes  No
C5.3 Do you use documented systems and procedures to select when and how foreign
exchange contracts will be traded?
 Yes  No
C5.4 Do you use documented controls, including the assessment of credit risk, to lessen
the chance that counterparties are not able to perform contractual obligations?
 Yes  No
C5.5 Do you use documented systems to record all foreign exchange contracts?
 Yes  No
C5.6 Do you use documented processes for ensuring compliance with dealing and/or
exposure limits?
 Yes  No
Present C5.7 only if „retail clients‟ is selected at A5.1.1
C5.7 Do you have processes to review marketing material and disclosure documents to
ensure appropriate risk disclosures are made?
 Yes  No

C5.8 Are you currently an authorised foreign exchange dealer under the Banking (Foreign
Exchange) Regulations
 Yes  No
A No response triggers C5 proofs

Australian Securities and Investments Commission, February 2010 Page 45 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question C6 Horse Racing Syndicate

Present only where A4.2.3.7.5 or A4.2.4.7.5 have been selected
To be authorised to operate a horse racing syndicate you must show that you have
processes and systems to adequately manage this particular syndicate. For more details
see ASIC's Regulatory Guide 91 Horse racing and breeding schemes (RG 91).
C6.1 Will you use a documented process to ensure the horse racing syndicates you wish
to operate under your AFS have and maintain separate trust accounts?
 Yes  No
C6.2 Will you prepare annual statements of financial performance and financial position
for each horse racing syndicate you wish to operate?
 Yes  No
C6.3 Will you use a documented process for managing your relationship with the lead
regulator for each of your syndicates?
 Yes  No

Australian Securities and Investments Commission, February 2010 Page 46 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question C7 Life Products

Present only where one of the following has been selected A4.1.2.6.1, A4.1.2.6.2,
A4.2.3.6.1, A4.2.3.6.2, A4.2.4.6.1, A4.2.4.6.2
To be authorised to advise/deal in investment life insurance or life risk insurance products
you must show that you have processes and systems to adequately manage this particular
product.
C7.1 Have you advised/dealt in these products previously?
 Yes  No
If No go to C7.2, if Yes:
C7.1.1 How long have you advised or dealt in these products?
 Less than 1 year
 1 year to 5 years
 5 years to 10 years
 More than 10 years
C7.2 What percentage of your financial products income is derived from advising and/or
dealing in life products?
 Less than 25%
 25% to 50%
 50% to 75%
 Greater than 75%
C7.3 Do you use a process to monitor the practices of your representatives particularly in
relation to churning and/or twisting?
 Yes  No

Australian Securities and Investments Commission, February 2010 Page 47 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question C8 Underwriting
Present only where Yes has been selected at A5.4.
To be authorised to act as an underwriting agent or a general insurance broker acting
under binders you must show that you have adequate processes and systems to manage
this particular product.
C8.1 Will you be entering into agreements involving more than one insurer or reinsurer?
 Yes  No
C8.2 Do you use documented processes to ensure that cover is protected if any insurer
withdraws from or chooses not to renew these agreements?
 Yes  No
C8.3 Have you reviewed your agency agreements with insurers to assess if they are in
conflict with any of your AFS licence obligations and the law?
 Yes  No
if Yes go to C8.3.1 if No go to C8.4
C8.3.1 Were any conflicts identified?
 Yes  No
if Yes go to C8.3.1.1 if No go to C8.4
C8.3.1.1 Have you amended, or do you propose to amend, the agreements
to remove all such conflicts?
 Yes  No
C8.4 Do any of your agreements with insurers specify any time limits for remitting
premiums to the insurer?
 Yes  No
if Yes go to C8.4.1 if No go to C8.5
C8.4.1 Do the agreements purport to reduce or invalidate insurance cover for
failure to remit premiums within the agreed timeframe(s)?
 Yes  No
C8.4.2 What is the time limit for remitting funds?
 Less than 30 days  60 to 90 days
 30 to 60 days  greater than 90 days
C8.5 Do you use a documented process to ensure you properly notify insurers, within
agreed timeframes, that they are on risk?
 Yes  No

C8.6 Are you liable under agreements with insurers for part of any claim on business that
you have underwritten??
 Yes  No
if Yes go to C8.6.1 if No go to C8.7
C8.6.1 Which of the following measures best describes what you have in place for
any abnormal underwriting losses that may occur?
 Reinsurance contracts
 Cash reserves
 Stop loss insurance cover
 None of the above

Australian Securities and Investments Commission, February 2010 Page 48 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

C8.7 Do you use a documented process to ensure you appropriately notify retail clients
as to whom you represent, eg an insurer or the retail client themselves?
 Yes  No

Australian Securities and Investments Commission, February 2010 Page 49 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question C9 Managed Discretionary Account Services

To be presented to retail applicants (A5.1.1 selected), and where A4.2.3.7.7 and/or
A4.2.3.12.1.1 has been selected.

To be authorised to operate an MDA service you must demonstrate that you have the
processes and systems in place to adequately operate this service and ensure compliance
with your obligations under Class Order [CO 04/194].

C9.1 Do you have a documented process to ensure that your Financial Services Guide
(FSG) will contain information on the MDA service you operate?
 Yes  No
C9.2 Do you use a documented process to ensure client account details are accurate and
secure?
 Yes  No
C9.3 Do you use a documented process to ensure that client assets are managed as a
discrete portfolio?
 Yes  No
C9.4 Do you use a documented process to ensure that the investment program you
include in the MDA contract is appropriate for the client?
 Yes  No
C9.5 Do you use a documented process to ensure that the investment program for each
retail client is reviewed at least once every 12 months?
 Yes  No
C9.6 Do you have a documented process to ensure compliance with retail client's
instructions on corporate actions and communications about portfolio assets?
 Yes  No
C9.7 Do you have a documented process to report regularly to the client to enable the
client to monitor the performance of and trading in their portfolio?
 Yes  No
C9.8 Do you have a documented process to maintain records of the documents provided
to each retail client?
 Yes  No
C9.9 Who will hold legal title to portfolio assets?
 The MDA operator
 an external MDA custodian that directly contracts with the MDA client
 the MDA client
 a custodian appointed by the MDA operator
If C9.9.1 and/or C9.9.4 is selected then A3.1.5 must be selected, if not present
the message "You need to select the appropriate financial service to perform this
role. Refer to Part 2 of the ASIC Licensing Kit (RG 2) on ASIC's website for
guidance."

Australian Securities and Investments Commission, February 2010 Page 50 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Question C10 Margin Lending Facility

To be presented to retail applicants (A5.1.1 selected), and where A4.2.3.11.1 and/or
A4.2.3.11.2 has been selected.

C10.1 Do you use a documented process to assess whether the margin lending facility is
unsuitable for the retail client if the facility is issued or the limit is increased?
 Yes  No
C10.2 Do you have a documented process to ensure that a retail client who requests a
copy of the assessment of unsuitability in relation to the issue or increase in limit of a
margin lending facility is given a copy of the assessment within the time and manner
required by s985H of the Corporations Act 2001?
 Yes  No
C10.3 Do you use a documented process to monitor clients‟ margin lending facilities to
detect when the facility goes into margin call?
 Yes  No
C10.4 Do you have adequate operational capacity to continue to monitor margin lending
facilities in the event of multiple simultaneous margin calls (e.g. significant sudden market
loss)?
 Yes  No
C10.5 Do you use a documented process to ensure that reasonable steps are taken to
notify clients in an appropriate time and manner when a margin call occurs?
 Yes  No
C10.6 Have you made arrangements with an agent (i.e. another financial services
licensee, such as a financial adviser) and a retail client for the agent to notify the client of
margin calls?
 Yes  No
If yes,
C10.6.1 Do you have documented procedures to ensure that reasonable steps are
taken to notify the agent when a margin call occurs?
 Yes  No

Australian Securities and Investments Commission, February 2010 Page 51 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

PART D - DECLARATIONS AND CERTIFICATIONS

GENERAL DECLARATION AND CONSENT (ALL)
The applicant declares that, to the best of its knowledge, the information supplied in, and
with, this application is complete and accurate.
The applicant declares that, if granted the licence, it will comply with its obligations as a
financial services licensee.
The applicant acknowledges that the Australian Securities and Investments Commission
may take action to verify that the statements and certifications made in relation to this
application were not false or misleading.
The applicant acknowledges that it has read the ASIC Electronic Lodgement Protocol and
agrees to be bound by its terms and conditions. (eLicensing initial applications only)
The applicant declares that this application is lodged in accordance with the ASIC
Electronic Lodgement Protocol (including that a signed copy of this application will be
maintained by the applicant in accordance with the protocol). (AFS licence variation
applications only)
APRA REGULATED BODIES DECLARATION AND ACKNOWLEDGMENT WHERE YES TO A5.3 ONLY
The applicant declares that the applicant is a body regulated by APRA (within the meaning
of s3(2) of the Australian Prudential Regulation Authority Act 1998).
SPECIFIC CERTIFICATIONS
I certify that as at the date of this application to the best of my knowledge the
following is true:
the responsible managers named in this application have completed the statement of
personal information (where required) and the applicant believes the responsible
managers are of good fame and character
the responsible managers named in this application have the relevant knowledge, skills
and experience to perform their particular roles within this business
the applicant has, and will continue to have, measures in place to maintain the
competence required to provide the financial services applied for in this application
the applicant has, and will continue to have, appropriate measures in place to provide
the financial services applied for in this application efficiently, honestly and fairly
the applicant has established, and will maintain, compliance measures that are
appropriate and will ensure that it complies with the obligations under the financial
services laws
the applicant has established, and will maintain, adequate monitoring, supervision and
training procedures to ensure that representatives will comply with the requirements
of the financial services laws, are properly trained and are competent to undertake
their role when they join the applicant's financial services business and on an ongoing
basis

the applicant has sufficient resources available to meet its obligations under the
financial services laws and will continue to have sufficient resources on an ongoing
basis, including:

Australian Securities and Investments Commission, February 2010 Page 52 of 59

 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

adequate human resources to enable it to satisfy its obligations under

the financial services laws;
adequate technological resources to enable it to satisfy its obligations
under the financial services laws
adequate financial resources to enable it to satisfy its obligations under
the financial services laws.
the applicant has, and will continue to have, appropriate internal and external dispute
resolution procedures to resolve complaints made in connection with the provision of
the financial services applied for in this application.
the applicant has established and will maintain adequate risk management systems
that take into account the nature, scale and complexity of this financial services
business and include a focus on its obligations under the financial services laws
the applicant has, and will maintain, compensation arrangements that comply with the
requirements of the financial services laws
the applicant has, and will continue to have, sufficient financial resources available to
meet the financial requirements set out in ASIC's Regulatory Guide 166 Licensing:
Financial requirements (RG 166)
WARNING:
It is an offence under the Corporations Act to provide false or misleading information to
ASIC. False or misleading information in an application (including a material omission) may
also be grounds to revoke any licence granted based on the application.
SIGNATORIES
The signature block for the applicant will vary according to the type of applicant. Each
signatory will be required to sign and date.
Individual To be signed by that individual. Name to be pre-filled from
A1.1
Partnership To be signed by all the partners who would perform duties in
connection with the holding of the licence. Signatory blocks
equal to number given at A1.1.2.1 presented for completion of
name, signature & date.
Company To be signed by two directors of the company; a director and
a company secretary of the company; or a single director for a
single director company. Signature block should default to
the one "director" and one "director/secretary" block.
Signatory will need to print their name as well as sign and
date.
Non-Corporate Trustees To be signed by all the trustees. Signatory blocks equal to
number given at A1.1.4.2 presented for completion of name,
signature & date.

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 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Part E - Proofs
Attachments
You must provide the following core proofs as evidence to support your AFS licence
application:
A5 Business Description
People Proofs for each responsible manager (these include a Statement of Personal
Information, bankruptcy check, criminal history check and two business references)
B1 Organisational Competence (this includes a Table of Organisational Competence
and, if relevant, a Submission supporting Responsible Manager's competence)
B5 Financial Statements and Financial Resources Details (you don‟t have to send this
proof if you are a body regulated by APRA).

Part 2 of the AFS Licensing Kit (RG 2) explains what these proofs should look like and the
information we expect them to include. Make sure you label your proofs as shown below.

Once we‟ve started assessing your application, you may need to provide additional proofs.
These will generally be one or more of the proofs listed below. However, we may need to
ask you for other proofs not listed here if you haven‟t selected your authorisations
correctly. All of the additional proofs are described in Part 3 of the AFS Licensing Kit
(RG 3).

Each attached proof must be labelled in the approved format as follows:

Label Sample

Applicant name: [insert name of applicant]

Application number: [insert application reference number]
Attachment name: [insert name of attachment]
Number of pages: [insert number of pages]
Date prepared: [insert date]
Special status if any: [eg Commercial-in-confidence, Draft Only, etc]

PRIVACY NOTICE
The information you give in these proofs assists ASIC to assess whether it should grant the
applicant an Australian financial services licence. ASIC is empowered to collect this
information and will not use it for any other purpose, nor will we disclose it, unless we
have obtained consent or the use or disclosure is permitted under the Privacy Act (Cth).

For more details, see the Privacy Statement on our website www.asic.gov.au.

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 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Part A Proofs
A1: APPLICANT DETAILS
Partnership Statement
Trustees of a Trust Statement
Other entity types
A4: AFS LICENCE AUTHORISATIONS
Miscellaneous Financial Facility Statement
Authorised Expressions – Membership
A5: BUSINESS DESCRIPTION
Business Description Proof

People Proofs
People Proofs for all responsible managers (incl. A Statement Of Personal Information)

Part B Proofs
B1: ORGANISATIONAL COMPETENCE
Submission Supporting Responsible Manager's Competence
Table of Organisational Competence
B2: ORGANISATIONAL COMPETENCE
Development Program for Responsible Managers
Industry Standards Compliance
B3: COMPLIANCE ARRANGEMENTS
Compliance Arrangements
Arrangements for Managing Conflicts of Interests
Outsourcing Statement
B4: REPRESENTATIVES
Program for Monitoring, Supervision and Training of Representatives
B5: ADEQUACY OF RESOURCES
Financial Statements and Financial Resource Resources Details
Human Resource Capacity Statement
Information Technology Capacity Statement
B6: DISPUTE RESOLUTION
Dispute Resolution System Statement
B7: RISK MANAGEMENT
Risk Management System Statement
B8: COMPENSATION
Compensation Capacity Statement
B9: RESEARCH AND BENEFITS

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 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Research Statement

Part C Proofs
C1: CUSTODIAL OR DEPOSITORY SERVICE
Custodial/Depository Service Statement
IDPS Statement
Funds Under Management/Custody Statement
Product/Service Distribution Statement
C2: OPERATE A REGISTERED MANAGED INVESTMENT SCHEME
Scheme Operating Capacity Statement
Scheme Property Statement
Funds Under Management Details
Product Distribution Channel Report
C3: MAKE A MARKET
Market Maker Statement
C4: DERIVATIVES
Derivatives Statement
C5: FOREIGN EXCHANGE
Foreign Exchange Operating Statement
C6: HORSE RACING SYNDICATE
Horse Racing Syndicate Statement
C7: LIFE INSURANCE
Life Insurance Capacity Statement
C8: UNDERWRITING AGENCY AND/OR GENERAL INSURANCE BROKER ACTING UNDER BINDERS
Underwriting Agency Capacity Statement
C9: MANAGED DISCRETIONARY ACCOUNT
MDA Operator Capacity Statement
C10: MARGIN LENDING FACILITY
Margin Lending Facilities Provider Statement
If applicable,

FS03 APPLICATION: VARIATIONS TO CONDITIONS (OTHER THAN AUTHORISATIONS)

Documents to support variation

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 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

Statement of Personal Information

Banner with Legal Name and ABN of Applicant
To obtain an AFS licence, an applicant must show that they have the experience and expertise
to ensure that the financial services to be covered by the AFS licence will be provided
efficiently, honestly and fairly.
You have been nominated as a responsible manager for this application.
To demonstrate that you have the necessary experience, competence and are of good fame and
character, please respond to all of the following questions.
When signed, this Statement becomes (if a required proof) an attachment to the AFS licence
application or the Change of details of an Australian financial services licence. These documents
will be forwarded to the Australian Securities and Investments Commission (ASIC) by the licensee
or proposed licensee.
PRIVACY NOTICE
The information you give in this Statement of Personal Information assists ASIC to assess whether
it should grant the applicant an Australian financial services licence. ASIC is empowered to
collect this information and will not use it for any other purpose, nor will we disclose it, unless
we have obtained consent or the use or disclosure is permitted under the Privacy Act (Cth).

For more details, see the Privacy Statement on our website www.asic.gov.au.

Statement of Personal Information for prefill name from B1, to support an application
for an Australian financial services licence (AFS licence)
Within the last 10 years, within Australia and/or overseas:
1. Have you been refused the right, or been restricted in the right, to carry on any trade,
business or profession for which a licence, registration or other authority is required by
law?
 Yes  No
2. Have you been a member, or partner in a member firm, of any securities, stock, futures,
commodities or other exchange?
 Yes  No
3. Have you been suspended from membership of, or disciplined by, any securities, stock,
futures, commodities or other exchange?
 Yes  No
4. Have you been refused membership of any securities, stock, futures, commodities or
other exchange?
 Yes  No
5. Have you been removed from membership of, or disciplined by, any professional body?
 Yes  No
6. Have you carried on business under any name other than the name or names shown in
this application?
 Yes  No
7. Have you been known by any name other than the name or names shown in this
application?
 Yes  No

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 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

8. Have you been the subject of any findings, judgment or current proceeding, including
findings, in relation to fraud, misrepresentation or dishonesty, in any administrative, civil
or criminal proceedings in any country?
 Yes  No
9. Are you, or have you ever been, declared bankrupt or insolvent under administration?
 Yes  No
10. Have you been engaged in the management of any companies/businesses that have had
an external administrator appointed?
 Yes  No
11. Have you been engaged in the management of any companies/businesses that were
declared insolvent?
 Yes  No
12. Have you been engaged in the management of any companies/businesses that were
declared the equivalent of insolvent under the law of an external territory or country
other than Australia?
 Yes  No
13. Have you ever been engaged in the management of any company that has had an
instrument of approval under the Superannuation Industry (Supervision) Act 1993
revoked?
 Yes  No
14. Have you ever been engaged in the management of any companies/businesses that have
had a Corporations Act 2001 (or previous corresponding laws) licence or Insurance Agents
and Brokers Act 1984 registration revoked or suspended?
 Yes  No
Attachments
A. If you have answered Yes to any question, please provide a separate attachment that
includes individual details. In addition, please provide the following:
Question 8 the judgment and if it has been satisfied
Question 9 to 12 For a declaration of bankruptcy or insolvency:
 date of the declaration and district in which it was made
 bankruptcy number
For a deed of arrangement, assignment or where creditors
have accepted a composition under Part X of the Bankruptcy
Act 1966:
 date of the deed of arrangement, assignment or the
special resolution accepting composition and the district
in which it was made
 name and address of the trustee of the deed of
arrangement, assignment or of the composition
 identifying number used in relation to the deed of
arrangement or assignment or the composition in the
office of the Registrar in Bankruptcy
B. You must provide the following details of your educational qualifications relevant to your
responsibilities for this AFS licence. If insufficient space, attach an annexure. If any of

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 SAMPLE APPLICATION – LIST OF ALL POSSIBLE QUESTIONS

your qualifications are foreign qualifications, please provide details about how the
qualification has been approved by the National Office of Overseas Skills Recognition
(NOOSR) in Canberra – for example, the letter verifying the qualification provided to you
by NOOSR, and what Australian short courses you have completed.
Institution ______________________________________
Course Name ______________________________________
Year of completion ______________________________________

Institution ______________________________________
Course Name ______________________________________
Year of completion ______________________________________

Institution ______________________________________
Course Name ______________________________________
Year of completion ______________________________________
C. The proposed or existing licensee must provide the following documents to support your
Statement. If you are a body regulated by APRA, you do not need to provide these
documents.
an Australian Federal Police (AFP) check on you not more than 12 months old
(original or certified true copy of)
an Insolvency Trustee Services Australia (ITSA) Bankruptcy check on you not
more than 12 months old (or a statutory declaration for overseas responsible
managers)
two business references, in the approved format, not more than 12 months old
(original or certified true copy of), refer to Part 2 of the AFS Licensing Kit
(RG 2) for details
Declaration
I pre-fill with Name from B1, agree to be a responsible manager for pre-fill with Legal Name
and ABN, as defined by the Corporations Act.
I certify that the information in this Statement and all attachments are true and correct.
Witness
Name: __________________________
Signed __________________________ Address __________________________
Role __________________________ __________________________
Date __________________________ Signed __________________________
Date __________________________

Australian Securities and Investments Commission, February 2010 Page 59 of 59