FORM LCM

APPLICATION FOR LICENCE TO CARRY ON

LABUAN COMPANY MANAGEMENT BUSINESS

IMPORTANT NOTES
1. The completed application form and supporting documents should be submitted to:

Head of Authorization and Licensing Unit

Labuan Financial Services Authority
Level 17, Main Office Tower
Financial Park Complex
Jalan Merdeka
87000 Labuan F.T.
Malaysia

2. Applicant may also submit a soft copy of the completed application form and supporting
documents via email to licensing@labuanfsa.gov.my for preliminary review by the officer.

3. Submission of application which does not comply with Labuan FSA’s requirement or
which are unsatisfactory may be returned.

4. The form and supporting documents serves as general requirement of the application,
Labuan FSA reserves the right to request for additional information and/or documents to
support the application.

5. Any information supplied pursuant to this form will be dealt with in confidence in
accordance with Section 178 of the Labuan Financial Services and Securities Act
2010/Section 139 of the Labuan Islamic Financial Services and Securities Act 2010.

6. Documents may be certified by any authorised person including, but not limited to,
commissioner for oaths, notary public, certified public accountants, advocates or
solicitors, company secretaries and Malaysian/foreign embassies. Copy of bank
statements must be certified by the bank. Where documents are not in the national
language of Malaysia or in English, please provide English-translated version of the
documents, duly certified/notarized.

7. This document belongs to Labuan FSA, no modification or tampering with the format or
its contents is permitted.

8. Labuan FSA has a whistle blowing policy in place where suppliers, consultants or even
members of the public can report to the Designated Officers in writing as per the Whistle
Blowing Disclosure Form if there is any element of wrongdoings by any staff of Labuan
FSA or its subsidiaries in relation to the application or licence being awarded.

9. For details of applicable legislations and guidelines pertaining to company management

business, please visit our website at www.labuanfsa.gov.my.

10. Processing fee and client charter:

Processing Fee
Type of Processing Client Charter
(USD)
Normal 350.00 30 working days
Fast Track 1,550.00 15 working days
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IMPORTANT NOTES
11. Terms and conditions of fast track application:
(i) Labuan FSA reserved the right to accept or decline any fast track application
submitted.
(ii) The fast track processing timeline will only commence upon compliance with the
following:
(a) Submission of complete documentation;
(b) Payment of fast track processing fee; and
(c) Acceptance of fast track application by Labuan FSA.
(iii) The fast track processing fee will be forfeited should the applicant decided to
withdraw after the fast track application has been accepted by Labuan FSA.
(iv) Labuan FSA reserved the right to change the status of the application from fast track
to normal processing. The applicant will be notified and the fast track processing fee
paid will be refunded accordingly.

GENERAL INFORMATION
Important: All fields are mandatory and should not be left blank

1. Party responsible for submission of application 1:

Applicant’s Shareholder/Head Office Labuan Trust Company

Others:_________________________
(please specify)

2. Officer responsible for submission of application:

Name :________________________ Company :_____________________

Designation :_________________________ Contact No. :_____________________

Email :________________________ Signature :_____________________

3. How do you know about Labuan IBFC?

Website Newspaper/Media

Previous Experience Business Referral

Labuan Trust Company Labuan IBFC Inc. Sdn. Bhd. 2

Others:_______________________
(please specify)

4. Consent for disclosure of information to be used for marketing/promotional purposes by Labuan

FSA and Labuan IBFC Inc. Sdn. Bhd.:

Yes No

1 With the exception of the applicant’s shareholder/head office, party responsible for submission of application is
required to submit the duly completed Statutory Declaration as attached in Appendix VI.
2 Labuan IBFC Inc. Sdn. Bhd. was incorporated in July 2008 as the sole official Malaysian agency authorised to
promote, market and develop the benefits of Labuan IBFC as the premier international business and financial centre
in Asia Pacific.
 FORM LCM

APPLICATION FOR LICENCE TO CARRY ON

LABUAN COMPANY MANAGENENT BUSINESS
Sections 131, Labuan Financial Services and Securities Act 2010

PART I : PROFILE OF APPLICANT

Important: All fields are mandatory and should not be left blank

Name of Applicant
a. (refers to the proposed
Labuan company)
Type of Licence Applied
b. (Please tick ( √) the Conventional Islamic
appropriate box)

Nature of Legal Entity Labuan Company - Subsidiary

(Please tick (√) the
c.
appropriate box) Foreign Labuan Company - Branch

Marketing Office to be
d. Established Yes No
(Please tick (√) the
appropriate box)

Proposed Paid-up
e. Capital/Working Fund
(please specify currency
used)

Country of Percentage of
Proposed Name of Shareholder(s)
Origin Shareholding(s)
Shareholder(s)
f. (each of shareholder is
required to complete Part II
and/or Part III)

Proposed Director(s)/ Name of Director(s) Nationality Position to be Held

g.
Principal Officer
(each of Director/Principal
Officer is required to
complete Part IV)
Years of Experience
Name of Advisor(s) Nationality in Islamic Financial
Proposed Shariah Business
Advisor(s)
h. (each of Shariah Advisor is
required to complete Part
IV)

Any Other Information

Relevant For
i.
Consideration of the
Application
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PART II : PROFILE OF CORPORATE SHAREHOLDER(S)

Important: All fields are mandatory and should not be left blank

Name of Company/
a.
Head Office

b. Company Address

c. Nature and Type of

Business
Incorporation/
d.
Registration Number
Date and Place of
e. Incorporation/
Registration
Date, Type of Licence
f. and Licence Number
(if applicable)
Home Supervisory
g. Authority
(if applicable)
Retained
Paid-up Profits/
Shareholders’ Fund Year Other Reserves
Capital Accumulated
(please specify currency
and amount for the latest Losses
h. three(3) years)

Profit/(Loss)
Financial Performance Year Total Assets Total Liabilities
Before Tax
(please specify currency
i. and amount for the latest
three (3) years)

Country of Percentage of
Name of Shareholder(s)
Origin Shareholding(s)
j. Shareholder(s)

Nature of
Name of Director(s) Nationality Appointment
(executive or non-
executive)
k. Board of Director(s)
 FORM LCM

PART III : PROFILE OF INDIVIDUAL SHAREHOLDER(S)

Important: All fields are mandatory and should not be left blank

a. Salutation

Name
b.
(as per NRIC/passport) Please tick (√) if the individual is a PEP

Date and Place of

c. Birth

d. Gender Male Female

e. Nationality

Old IC No.:
NRIC Details
f.
(for Malaysian) NRIC No.:

Passport No.:

Expiry Date:

Country of Issue:

Issuing Authority:
Passport Details
g. Length of residence in Malaysia:
(for Non-Malaysian)

Any work permit applied prior to this application:

No Yes
(please provide certified true
copy of the work permit)

a) Net Worth Statement Certified by Qualified Accountant; or

Currency and Amount

Total Assets

Total Liabilities

Financial Net worth b) Bank Statement/Online Bank Statement Certified by the Bank
(latest three months Currency
bank statement duly Type of
Name of Bank Statement Date and
certified by the Bank or Account
h. Amount
net worth statement
prepared and certified by
Qualified Accountant)
 FORM LCM

PART III : PROFILE OF INDIVIDUAL SHAREHOLDER(S)

Important: All fields are mandatory and should not be left blank

i. Curriculum Vitae of Individual Shareholder

Section A: Tertiary / Highest Education(s)

Year
Name of School/College/
Type of Qualification/ Certification Qualification
University/Others
Obtained

Section B: Professional Qualification(s)

Year
Type of Qualification/Certification Name of Institution Qualification
Obtained

Section C: Membership of Professional Body(s)

Year
Type and Details of Membership Name of Institution Membership
Obtained

Section D: Past and Current Work Experience(s)

Date
(dd/mm/yy) Key Areas of
Name of Employer Designation
Responsibilities
From To

Section E: Directorship Held in Other Company(s)

Date of Nature of
Name of Corporation Place of Incorporation Appointment Appointment
(executive or non-
(dd/mm/yy)
executive)
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PART IV: PROFILE OF DIRECTOR(S)/PRINCIPAL OFFICER/SHARIAH ADVISOR(S)

Important: All fields are mandatory and should not be left blank

a. Position to be Held

b. Salutation

Name
c. (as per NRIC/passport)
Please tick (√) if the individual is a PEP

d. Date and Place of Birth

e. Gender Male Female

f. Nationality

Old IC No.:
NRIC Details
g.
(for Malaysian)
NRIC No.:

Passport No.:

Expiry Date:

Country of Issue:

Issuing Authority:

Passport Details Length of residence in Malaysia:

h.
(for Non-Malaysian)
Any work permit applied prior to this application:

No Yes
(please provide
certified true
copy of the work
permit)

i. Curriculum Vitae of Director/Shariah Advisor

Section A: Tertiary / Highest Education(s)

Year
Type of Qualification/ Certification Name of College/University/Others Qualification
Obtained
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PART IV: PROFILE OF DIRECTOR(S)/PRINCIPAL OFFICER/SHARIAH ADVISOR(S)

Important: All fields are mandatory and should not be left blank

Section B: Professional Qualification(s)

Year
Type of Qualification/ Certification Name of Institution Qualification
Obtained

Section C: Membership of Professional Body(s)

Year
Type and Details of Membership Name of Institution Membership
Obtained

Section D: Past and Current Work Experience(s)

Date
(dd/mm/yy) Key Areas of
Name of Employer 3 Designation
Responsibilities
From To

Section E: Directorship Held in Other Company(s)

Nature of
Name of Corporation Place of Incorporation Date of Appointment Appointment
(dd/mm/yy) (executive or
non-executive)

3
If the position applied for requires approval from relevant authority, please give detail of the approving authority
(applicable to current employment only).
 FORM LCM

PART V : PARTICULARS OF THE APPLICATION

Important: All fields are mandatory and should not be left blank

Section A: Business Plan (Please fill in the details, where applicable)

a. Objective of Establishment

b. Type of Products/Services

Target Market Territorial Scope %

c. (to specify whether it is individual
and/or corporate client and the
percentage)

Territorial Scope %
Territorial Scope
d. (to specify the country and
percentage)

Business Operational and Strategic Plan

e. (a credible and viable business plan included but not limited to the following that sets out the approach to
implement the proposed business objectives or operations)

 Treasury Processing
Services

 Managerial Services

Internal policies and controls

f. that commensurate with the
business profile or risks

g. Marketing Strategy

Non- Expected
Category Malaysian Total
Malaysian Remuneration
(a) Managerial &
Professional
(b) Technical &
Supervisory
(c) Production /
Operation
h. Manpower Planning Workers
- Skilled
- Unskilled
(d) Clerical &
General
Workers
Total
(a)+(b)+(c)+(d)

Functional Structure of
i
Management Office in Labuan
 FORM LCM

PART V : PARTICULARS OF THE APPLICATION

Important: All fields are mandatory and should not be left blank

Functional Structure of
j. Marketing Office
(if any)

Section B: Three Years Financial Projection (*fill in where applicable)

Currency:

Statement of Comprehensive Income Year 1 Year 2 Year 3

Revenue

Operating Expenses

Operating Profit/(Loss)

Other Income

General and Administrative Expenses

Income/(Loss) Before Tax

Tax

Income/(Loss) After Tax

Statement of Financial Position Year 1 Year 2 Year 3

ASSETS

Non-current assets

Current assets

Total Assets

LIABILITIES

Long term liabilities

Short term liabilities

Total Liabilities

SHAREHOLDERS’ FUNDS / HEAD OFFICE ACCOUNT

Head office account / paid up capital

Retained profits / accumulated losses

Other reserves
Total Shareholders’ Funds / Head
Office Account

Note:
1. Please ensure the three years projection is realistic and reasonable.
2. Please provide basis of assumption in deriving to the projected figure.
3. The above information is a guidance for the applicant to complete the financial projection.
 FORM LSCM

PART VI : SUPPORTING DOCUMENTS

(Please √ at the appropriate box and provide reason(s)/justification(s) for any non-submission)
For
For
No Documents Labuan
Applicant
FSA

Part II: Corporate Shareholder(s)

1. Detailed information of applicant’s shareholder(s) or head office:
a) Group corporate shareholding structure including the applicant
b) Certified true copy of certificate of incorporation
c) Certified true copy of certificate of licence granted by relevant authority(s)
in its home country - (if applicable)
d) Letter of awareness or approvals of authorities from the home country, if
applicable, which includes:
(i) Statement of no objection towards the establishment of a subsidiary or
branch in Labuan.
(ii) Confirmation that the applicant’s shareholder or head office is of good
financial standing.
(iii) Agreement to co-operate in the supervision of the proposed subsidiary
or branch in Labuan in terms applicable regulatory standards.
e) Certified true copy of board resolution or minutes of general meeting which
approved the setting up of the applicant
f) Certified true copy of memorandum & articles of association

g) Copy of two (2) years audited financial statements/annual reports

2. Letter of guarantee or undertaking by:

a) applicant’s shareholder, if applicant is a subsidiary (format as per Appendix
I)
b) applicant’s head office, if applicant is a branch (format as per Appendix II)
Part III: Individual Shareholder(s)
1. Certified true copy of NRIC (Malaysian) or passport (non-Malaysian)
2. Certified true copy of relevant academic and professional certificates
3. Two (2) referral letters from corporations, institutions and/or professional bodies
4. Net worth statement certified by qualified accountant or certified true copy of the
latest three months of bank statements indicating the amount of funds available
5. Letter of Guarantee by Individual Shareholder as per Appendix III
6. Statutory Declaration by Shareholder/Director on Fit and Proper Person as per
Appendix IV
Enhance Due Diligence report from the trust company / service provider, if
7.
applicable

Part IV: Director(s)/Principal Officer/Shariah Advisor

1. Certified true copy of NRIC (Malaysian) or passport (non-Malaysian)
2. Certified true copy of relevant academic and professional certificates
3. Two (2) referral letters from corporation, institutions and/or professional bodies
(not applicable for appointment within the group of companies)
4. Statutory Declaration by Shareholder/Director on Fit and Proper Person as per
Appendix IV
Enhance Due Diligence report from the trust company / service provider, if
5.
applicable
 FORM LSCM

PART VI : SUPPORTING DOCUMENTS

(Please √ at the appropriate box and provide reason(s)/justification(s) for any non-submission)
For
For
No Documents Labuan
Applicant
FSA

Other Supporting Documents

1. Proposed organisation chart of the applicant

2. Declaration of True and Correct Information Submitted as per Appendix V

3. Statutory Declaration by Services Provider Responsible for Submission of
Application as per Appendix VI
Framework on Know-Your-Customers’ policy and compliance to the Anti-Money
4.
Laundering, Anti-Terrorism Financing and Proceeds of Unlawful Activities Act
2001
 FORM LCM

Appendix I

Name and Address of Corporate Shareholder

[Date]

The Director General

Labuan Financial Services Authority
Level 17, Main Office Tower
Financial Park Labuan, Jalan Merdeka
87000 Federal Territory of Labuan
Malaysia

Dear Sir,

LETTER OF GUARANTEE

The application by [name of applicant], a subsidiary of [name of shareholder] to Labuan FSA

dated [date] for a licence to carry on Labuan [type of licence] business under the provisions of the
Labuan Financial Services and Securities Act 2010/Labuan Islamic Financial Services and
Securities Act 2010 [delete whichever not applicable] (hereinafter referred to as “the Act”) refers.

We, being the shareholder, do hereby irrevocably and unconditionally guarantee and undertake
in respect of [name of applicant]’s Labuan [type of licence] business, that during validity of [name
of applicant]’s license and its operation in Labuan IBFC, it shall comply with the following:

a. The financial obligations and requirements imposed under the Act on it and shall meet it’s
liabilities in respect of its Labuan [type of licence] business.
b. The requirement to obtain a prior written approval from Labuan FSA for:
i. any change of [name of applicant]’s shareholder who holds ten per centum or more
of its paid-up capital.
ii. any appointment of [name of applicant]’s director and Principal Officer, whom shall
be of a fit and proper person.
iii. any amendment or alteration to any of [name of applicant]’s constituent
documents.
c. The requirement to immediately notify Labuan FSA of any amendment or alteration to any
information which had been furnished to Labuan FSA in connection with the application
for the Labuan [type of licence] business.

We shall when so demanded in writing by Labuan FSA, on first demand, make good, meet and
honour the above requirements including, but not limited to, paying such sum of money in
satisfaction of such financial obligations, requirements and liabilities to the extent they are
properly due in such currency as may be specified by Labuan FSA, and on the basis such
payments extinguish such financial obligations, requirements and liabilities of [name of applicant]
and the Company.

Yours faithfully,

For and on behalf of

[Name of shareholder]

___________________
[Name]
Director
 FORM LCM

Appendix II

Letterhead of Head Office

[Date]

The Director General

Labuan Financial Services Authority
Level 17, Main Office Tower
Financial Park Labuan, Jalan Merdeka
87000 Federal Territory of Labuan
Malaysia

Dear Sir,

LETTER OF UNDERTAKING

The application by [name of applicant], a branch of [name of head office], to Labuan FSA dated
[date] for a licence to carry on Labuan [type of licence] business under the provisions of the
Labuan Financial Services and Securities Act 2010/Labuan Islamic Financial Services and
Securities Act 2010 [delete whichever not applicable] (hereinafter referred to as “the Act”) refers.
We, being the head office, do hereby irrevocably and unconditionally undertake in respect of
[name of applicant]’s Labuan [type of licence] business, that during validity of [name of applicant]’s
licence and its operation in Labuan IBFC, it shall comply with the following:
a. The financial obligations and requirements imposed under the Act on it and shall meet it’s
liabilities in respect of its Labuan [type of licence] business.

b. Requirement to notify Labuan FSA in writing within three months from the date of:
i. any change of [name of applicant]’s shareholder who holds ten per centum or more
of its paid-up capital.
ii. any appointment of [name of applicant]’s director and Principal Officer, whom shall
be of a fit and proper person.
ii. any amendment or alteration to any of its constituent documents.

c. The requirement to immediately notify Labuan FSA of any amendment or alteration to any
information which had been furnished to Labuan FSA in connection with the application
for the Labuan [type of licence] business.

We shall when so demanded in writing by Labuan FSA, on first demand, make good, meet and
honour the above requirements including, but not limited to, paying such sum of money in
satisfaction of such financial obligations, requirements and liabilities to the extent they are
properly due in such currency as may be specified by Labuan FSA, and on the basis such
payments extinguish such financial obligations, requirements and liabilities of [name of applicant]
and the head office.

Yours faithfully,

For and on behalf of

[Name of head office]

___________________
[Name]
Director
 FORM LCM

Appendix III

Name and Address of Individual Shareholder

[Date]

The Director General

Labuan Financial Services Authority
Level 17, Main Office Tower
Financial Park Labuan, Jalan Merdeka
87000 Federal Territory of Labuan
Malaysia

Dear Sir,

LETTER OF GUARANTEE

The application by [name of applicant], to Labuan FSA dated [date] for a licence to carry on
Labuan [type of licence] business under the provisions of the Labuan Financial Services and
Securities Act 2010/Labuan Islamic Financial Services and Securities Act 2010 [delete whichever
not applicable] (hereinafter referred to as “the Act”) refers.

I, being the [percentage of shareholding] shareholder of [name of applicant], do hereby irrevocably

and unconditionally guarantee and undertake in respect of [name of applicant]’s Labuan [type of
licence] business, that during validity of [name of applicant]’s licence and its operation in Labuan
IBFC, it shall comply with the following:

a. The financial obligations and requirements imposed under the Act on it and shall meet it’s
liabilities in respect of its Labuan [type of licence] business.

b. The requirement to obtain a prior written approval from Labuan FSA for:

i. any change of the [name of applicant]’s shareholder who holds ten per centum or
more of its paid-up capital.

ii. any appointment of [name of applicant]’s director and Principal Officer, whom shall
be of a fit and proper person.

iii. any amendment or alteration to any of [name of applicant]’s constituent documents.

c. The requirement to immediately notify Labuan FSA of any amendment or alteration to any
information which had been furnished to Labuan FSA in connection with the application
for the Labuan [type of licence] business.

I shall when so demanded in writing by Labuan FSA, on first demand, make good, meet and
honour the above requirements including, but not limited to, paying such sum of money in
satisfaction of such financial obligations, requirements and liabilities to the extent they are
properly due in such currency as may be specified by Labuan FSA, and on the basis such
payments extinguish such financial obligations, requirements and liabilities of [name of applicant].

Yours faithfully,

___________________
[Name of shareholder]
[NRIC or Passport No.]
 FORM LCM

Appendix IV

STATUTORY DECLARATION BY SHAREHOLDER/DIRECTOR/PRINCIPAL OFFICER

ON FIT AND PROPER PERSON
Important: All fields are mandatory and should not be left blank

I, ……………………………………………..NRIC/Passport No:……………………………….., a
shareholder/proposed director/principal officer of…………………………………………………..(name
of the Labuan company), do hereby solemnly and sincerely declare that:

1. I have read Section 4 of the Labuan Financial Services and Securities Act 2010
(LFSSA)/Section 4 of the Labuan Islamic Financial Services and Securities Act 2010
(LIFSSA) and the Guidelines on Fit and Proper Person Requirements issued on 11
February 2014 (the Guidelines).

2. to the best of my knowledge and belief in making this declaration and/or submitting the
attached documents in relation to this declaration, that I am a fit and proper person
based on the criteria stated under the said Section 4 of LFSSA/Section 4 of LIFSSA and
the Guidelines.

3. the information given in this declaration and in the attached documents (if any) are
accurate, true and complete.

4. I understand that if it is found that I have made false declaration herein and/or in the
attached document (if any), Labuan FSA is entitled to take any legal action including
disqualifying myself from acting in the capacity expressly mentioned herein.

And I make this solemn declaration conscientiously believing the same to be true and by virtue of the
provisions of the Statutory Declaration Act 1960 / ……………………………………………...(please
state any other relevant provisions).

Subscribed and solemnly declared by the above

named …………………….
At ………………………………. ……………………………….
In the State of …………………….. Signature
This …day of …. 20..

Before me,

…………………………..
(Commissioner for Oaths/Notary Public)
 FORM LCM

Appendix V

DECLARATION OF TRUE AND CORRECT INFORMATION SUBMITTED

Important: All fields are mandatory and should not be left blank

I……………………………………………………..NRIC/Passport No:…………….......................................
the …………..…………………….………(position in the applicant’s shareholder/head office)
of……………………….......................................................................................(name of the applicant’s
shareholder/head office), do hereby solemnly and sincerely declare that:
1. all information submitted in this application including all attachments, forms, documents and
forwarding letters are accurate, true and correct and that all estimations provided are fair and
reasonable.
2. I am aware that if I make any misrepresentation herein this application, it is an offence punishable
pursuant to Section 192 of the LFSSA.
3. a printed signed copy of this application which reflects the same information provided in this
application is being kept at the office of my principal or our appointed Labuan trust company being
the agent approved by Labuan FSA.

And I make this solemn declaration conscientiously believing the same to be true and by virtue of the
provisions of the Statutory Declaration Act 1960 / ……………………………………………...(please state
any other relevant provisions).

Subscribed and solemnly declared by the above

named ……………………..................
At ………………………………........... ……………………………….
In the State of ……………………....... Signature
This …....day of …................... 20......

Before me,

…………………………..
(Commissioner for Oaths/Notary Public)
 FORM LSCM

Appendix VI

STATUTORY DECLARATION BY SERVICE PROVIDER RESPONSIBLE FOR

SUBMISSION OF APPLICATION
Important: All fields are mandatory and should not be left blank

I, ……………………..(name) of …………………………….(address) NRIC/Passport No:…………… the

authorized officer of ………………………………………..(name of trust company/other service
providers) being the party responsible for the submission of application for
……………………………………..(name of applicant) do solemnly and sincerely declare that in relation
to the above application:

5. I have conducted due diligence process on…………………………. (name of applicant) and on its
director(s) and shareholder(s) and other persons or companies that involved and related to the
application and satisfied with the result thereof.

6. I am satisfied that the requirements of all legislations and applicable guidelines including but not
limited to Guidelines on Fit and Proper Person Requirements and Anti-Money Laundering, Anti-
Terrorism Financing and Proceeds of Unlawful Activities Act 2001 in respect of the above
application have been complied with.

And I make this solemn declaration conscientiously believing the same to be true, and by virtue of the
provisions of the Statutory Declaration Act 1960 / ……………………………………………...(please state
any other relevant provisions).

Subscribed and solemnly declared by

the above named …………………….
At ………………………………. ……………………………….
In the State of …………………….. Signature
This …day of …. 20..

Before me,

…………………………..
(Commissioner for Oaths/Notary Public)