PFN SUP 3 Application for approval for a Cell of a Protected Cell Company — Insurance

Past version: effective up to 31/05/2005
To view other versions open the versions tab on the right

Please download the Form in PDFPDF format.

Purpose of this form

An Authorised Firm wishing to apply for an additional Cell must submit this form.


This form consists of nine sections:

1. Authorised Firm details
2. Ownership details
3. Insurance business
4. General
5. Additional information
6. Money Laundering declaration
7. Declaration and signature
8. Attachments

Notes for completing this form

  • Defined terms are identified throughout this form by the capitalisation of the initial letter of a word or phrase and are defined in the Glossary module (GLO) of the DFSA Rulebook.

  • Sections 1, 2, 3, 4, 6 and 7 must be completed.

  • Please use section 5 if you wish to provide additional information that may clarify or support your answers in sections 1-4.

  • Questions must be fully answered and the use of abbreviations should be avoided.

  • Answers must be typed and the form must be signed by the Authorised Firm’s Senior Executive Officer.

  • Please ensure any supporting documentation is clearly labelled and securely attached.

  • When completed, submit this application form in line with SUP chapter 9. You may send applications by post or hand delivered and addressed to your usual supervisory contact.

The address for postal submission is:

PO BOX 75850

Derived from DFSA RM11/2004 (Made 16th September 2004). [VER1/09-04]