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APPLICATION FOR SUPERVISION BY

THE INSTITUTE OF CERTIFIED BOOKKEEPERS

Enter name under which you trade

The Institute of Certified Bookkeepers is a Supervisory Authority under The Money Laundering,

Terrorist Financing and Transfer of Funds (Information on the Payer) Regulations 2017(MLR17)

Royal Patron: HRH Prince Michael of Kent GCVO

by

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All person’s whether trading as a Sole Trader, Limited Company or Partnership offering Accounting

Services, are required to register with a Supervisory Authority. To trade without Supervision is an illegal

act and could incur both imprisonment and/or a fine

This form should be completed by members of IAgSA who are trading as above. A separate form should

be completed for each business ‘entity’.

Please complete as many boxes on the form as are applicable and provide as much information as

possible to enable ICB to understand how your business operates and how best to support you. Where

questions are not applicable, please write N/A

DETAILS OF YOUR PRACTICE

Your Practice is:

Sole Trader

Limited Company

Partnership

Limited Liability Partnership

Plc

Charity

Which of the following services does your Practice offer:

(tick as appropriate)

Bookkeeping

Accounting

Payroll

Self-Assessment Tax Returns

Corporation Tax Returns

Training

Administration

Limited Company registration number

(where applicable)

VAT registration number (where applicable)

Trading Address

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Beneficial Owners, Officers and Managers (BOOMs)

Regulation 26 of MLR 17 require all BOOMs to be approved by their Supervisory Body before a Licence

to Practice is granted. To enable ICB as your supervisor to approve your Licence to Practice a Basic

Disclosure Certificate is required for all BOOMs within your Practice. The Basic Disclosure Certificate

must be dated within the last 3 months.

Please list below all BOOMs and obtain a Basic Discloser Certificate for each of them.

You can obtain a basic disclosure certificate online via:

UK - https://www.gov.uk/request-copy-criminal-record NI - https://www.nidirect.gov.uk/campaigns/accessni-criminal-record-checks Scotland - https://www.mygov.scot/basic-disclosure/apply-for-basic-disclosure/ ICB will not approve your Licence to Practice without a Basic Disclosure Certificate

Main contact person

Telephone number

Mobile

Email address

Title First Name

Surname Date of Birth

Qualifications Full time Part time

Freelance

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Trust and Company Service Provider (TCSPs)

If you provide any of the services listed below you are a TCSP and will automatically be added to

HMRC’s TCSP Register as per the requirement of Regulation 54 of MLR17.

Do you allow any of your clients to use your address as

their Registered Office, correspondence/administrative Yes No

address or other related services?

Do you act as a Company Secretary, Director, Partner

or in any similar capacity for any of your clients? Yes No

Have you formed a company or other legal entity* for your

Clients? Yes No *Legal entities are an individual, company or other entity which has legal

rights and is subject to obligations

Do you, your practice, or anyone in your practice, hold shares

in a company on behalf of another person? Yes No

DECLARATION

Please answer yes or no to the following questions.

If you answer yes to any of the questions please provide further details on a separate sheet of paper.

Have you or any of the people listed above ever Yes No

been declared bankrupt or entered into an agreement

with creditors?

Do you or any of the people listed above have any criminal

convictions? Yes No

Have you or any of the people listed above ever been found

guilty of a civil offence? Yes No

I hereby apply for supervision by ICB under the MLR 17. I confirm that I am authorised to sign this form

on behalf of the business and that the information contained on this form is true and accurate to the

best of my knowledge. I have read, understood and agree to abide by ICB Rules of Professional

Conduct, as they exist now or may at any future date be amended. Once registered I agree to inform

ICB immediately of any change to the information contained on this form.

Signed

Name

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Date

METHOD OF PAYMENT

Please take the following payment for registration

I hereby provide payment for:

Practice Licence annual fee - £150

Practice Licence application fee (initial application only) - £50

Debit/Credit card

Type of Card Visa Mastercard Maestro

Card Number

Expiry date

Security Number (the last three digits in the reverse of card, next to signature strip)

Signature of card holder

Date

Cheque

Please find enclosed by cheque made payable to ICB

©The Institute of Certified Bookkeepers

122-126 Tooley Street, London, SE1 2TU England

Telephone: 0203 405 4000

www.bookkeepers.org.uk