I confirm that prior to completing this application I understand the entity’s obligations under the Act, and the
Financial Markets Supervisors Regulations 2014, and I have read and understood ‘Guidance Note: Supervisor
Licensing’ issued by the Financial Markets Authority.
I confirm (please tick those statements that are applicable):
Debt securities and/or registered schemes
The applicant is currently registered under the Financial Service Providers (Registration and
Dispute Resolution) Act 2008.
The applicant is compliant with section 13 (a) of the Financial Service Providers (Registration
and Dispute Resolution) Act 2008.
I, _______________ _______________ _______________, of __________________________________________
solemnly and sincerely declare the following:
that I have been authorised to act on behalf of the above named applicant in the making of this
that having conducted all necessary enquiries, I declare the information provided in this TRU2.1 Var
form is true and correct to the best of my knowledge,
Signature of person making declaration
Declared at this day of 20
Full name and desi
gnation of person to take statutory declaration
(Note: If you are making this declaration outside New Zealand, please ensure it is sworn in
accordance with section 11 of the Oaths and Declarations Act 1957).
- Page 3 of 5 -
Please initial here
And I make this solemn declaration conscientiously believing the same to be true and by virtue of
the Oaths and
Declarations Act 1957.