Compliance Service Enquiry Compliance Service Enquiry I want to know more about Moonstone’s:*Comprehensive Service (suitable for all FSP types)Protector Service (suitable for FSPs that are not required to link a Compliance Officer)Consultation Service (range of services including legal opinions and once-off compliance audits)My current FSP licence status:*I already have a FSP licenceI applied for a FSP licence and do not require any further assistance in this regardI am contemplating applying for a new FSP licence and want Moonstone to contact me for assistance in this regardName of Business*FSP Number (if authorised)Business Type:*Sole ProprietorClose CorporationPrivate CompanyPartnershipTrustPublic CompanyName of Contact Person* First Last Email Address of Contact Person* Enter Email Confirm Email Mobile Number of Contact Person*Landline Number of Contact Person*Business Website (if applicable) Business: Address Line 1*Business: Address Line 2SuburbPostal Code*City*Country*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwePlease assist us with expediting your service enquiry by providing us with the following information: Language Preference:*EnglishAfrikaansAre you a former Moonstone Compliance Service client?*YesNoCurrent or estimated number of Key Individuals linked to the licence*Please enter a value between 0 and 100.Current or estimated number of Representatives (natural persons) linked to the licence*Please enter a value between 0 and 100.Current or estimated number of Representatives (juristic persons) linked to the licence*Please enter a value between 0 and 100.Current or estimated number of additional FSP branches or office premises*Please enter a value between 0 and 100.Anticipated volume of new transactions per month*Please enter a value between 0 and 100.Who is your current/previous Compliance Officer/Compliance Practice, if applicable?If applicable, what are the reasons for changing your current Compliance Officer/Compliance Practice?What are your main requirements from your compliance service provider?Does the FSP currently render, or intend on rendering financial services via a call centre?*YesNoDo you have an internal compliance/legal department?*YesNoDoes the FSP currently act, or intend to act as an underwriting manager?*YesNoDoes the FSP currently collect, or intend to collect client premiums?*YesNoDoes the FSP have any outstanding compliance reports?*YesNoHas the FSP adopted a documented Compliance Risk Management Plan?*YesNoDid the FSP receive any complaints which were been referred to the Ombud in the last 5 years?*YesNoAre you in possession of any other financial services licences or memberships? (e.g. JSE Member, a Manager ito CISCA, or a Sec 13B Pension Fund Administrator)*YesNoIf Yes, please specify:*Any additional comments that you wish to communicate:Please indicate the FSP’s current (or anticipated) authorised licence category and financial product subcategories:Category I 1.1 Long-term Insurance A 1.2 Short-term Insurance: Personal 1.3 Long-term Insurance B1 1.4 Long-term Insurance C 1.5 Retail Pension Funds Benefits 1.6 Short-term Insurance: Commercial 1.7 Pension Fund Benefits 1.8 S & I: Shares 1.9 S & I: Money Market Instruments 1.10 S & I: Debentures 1.11 S & I: Warrants 1.12 S & I: Bonds 1.13 S & I: Derivatives 1.14 Collective Investments 1.15 Foreign Currency Denominated Investment Instrument (Forex) 1.16 Health Service Benefits 1.17 Long-term Deposits 1.18 Short-term Deposits 1.19 Friendly Society 1.20 Long-term Insurance B2 Category II 2.1 Long-term Insurance B1 2.2 Long-term Insurance C 2.3 Retail Pension Funds Benefits 2.4 Pension Fund Benefits 2.5 S & I: Shares 2.6 S & I: Money Market Instruments 2.7 S & I: Debentures 2.8 S & I: Warrants 2.9 S & I: Bonds 2.10 S & I: Derivatives 2.11 Collective Investments 2.12 Foreign Currency Denominated Investment Instrument (Forex) 2.13 Long-term Deposits 2.14 Short-term Deposits 2.15 Long-term Insurance B2 Category IIA Category IIA Category III Category III Category IV Category IV How did you hear about our Compliance service?*I was referredI did my RE’s through youWe’ve had previous dealings (Event / Licensing / Compliance)I receive your newslettersI attended an Event / Workshop where Moonstone presentedOnline Search brought me to your websiteAn promotional email from Moonstone prompted me to enquirePress article / print or onlineEmailThis field is for validation purposes and should be left unchanged.