APPLICATION FORMS AND NOTICES (AFN) – AUT - CON
                                                                                   For DFSA use only 
                                                                                         
                  Form AUT – CON
                  Applications and notifications 
                  concerning a change in control
                  Name of Authorised Firm                      
                  DFSA Reference Number                        
                             Firms are requested to contact the Supervision Department of the DFSA
                                (+9714 362 1500) before considering completing this application.
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                                                APPLICATION FORMS AND NOTICES (AFN) – AUT - CON
                Purpose of this form
                This form must be submitted by an Authorised Firm applying for approval or notifying the DFSA
                concerning a change in control of the Authorised Firm, this form may also be used by a Controller.
                Authorised Firms are required to complete a form for each application or notification.
                An Authorised Firm or Controller must submit an application or notification. As applicable, concerning
                a change in control, at least 28 days in advance of the proposed change, or immediately upon
                becoming aware of a proposed or actual change in control.
                Contents 
                Section    Title
                    1      Controllers (Individuals) 
                    2      Controllers (Undertakings) 
                    3      Details of new controls or change in level of control
                    4      Additional information 
                    5      Declaration
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                                                                   APPLICATION FORMS AND NOTICES (AFN) – AUT - CON
                      Notes for completing this form
                          Defined terms are identified throughout this application form by the capitalisation of the initial
                           letter of a word or phrase and are defined in the Glossary module (GLO) of the DFSA’s Rulebook.
                          Section 1 must be completed if the application/notification of a change in control relates to an
                           individual.
                          Section 2 must be completed if the application/notification relates to an Undertaking.  
                          Section 3 and 5 must be completed in respect of all applications/notifications. 
                          Please use Section 4 if you wish to provide additional information that may clarify or support your
                           answers in Sections 1-3. 
                          Questions must be answered fully and the use of abbreviations or acronyms should be avoided or
                           defined.
                              Answers must be typed in electronic format and the form must be signed by the relevant
                           Controller(s) and the Authorised Firm’s Senior Executive Officer or Compliance Officer. Versions
                           of this form on the DFSA’s website are in PDF format. Editable Microsoft Word versions can be
                           obtained from the DFSA.
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                                           APPLICATION FORMS AND NOTICES (AFN) – AUT - CON
               SECTION 1 – CONTROLLERS (INDIVIDUALS)
               Note: Please only complete this section if the application/notification relates to an individual 
               1.1  Title (Mr, Mrs etc.)          
               1.2  Family name                   
                
               1.3  Other names                   
               1.4  Residential address           
               1.5  Date of birth                 
                    (DD/MM/YYYY)
               1.6  Place of birth                
               1.7  Passport(s) number(s)         
                    Note: Please provide a copy of the 
                    passport
               1.8  Nationality                   
               1.9  Please provide details of any Directorships or Partnerships held 
               Company/Partnership name             Principal activity
                                                         
                                                         
                                                         
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