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(1)

 

MAR

 

RCH

 

2013

 

ELECTR

APPLICA

RONIC

 

R

 

ATION

 

F

ETAIL

 

PA

 

 

 

OR

 

AUT

AYMENT

 

 

 

 

 

 

HORIZAT

T

 

SERVIC

TION

 

CE

 

PROVIIDER

 

(2)

1

 

1.1

 

1.2

 

1.3

 

2.

 

2.1

 

2.2

 

3.

 

3.1

APPLI

Overview

In

 

accord

(Bank)

 

is

 

mandate

payment

were

 

de

framewo

system.

 

T

driving

 

th

All

 

electr

prior

 

to

 

commen

steps

 

to

 

s

of

 

any

 

ex

This

 

docu

electroni

The

 

Appl

The

 

Bank

April

 

201

Applicati

St

St

Stage

 

1

 

Stage

 

1

 

and

 

tech

the

 

appli

as

 

provid

a

b

c.

ICATION

 

FO

w

 

dance

 

with

 

S

charged

 

wit

e

 

the

 

Bank

 

is

t

 

services

 

se

veloped

 

and

ork

 

within

 

w

The

 

initiative

he

 

developm

ronic

 

retail

 

p

the

 

comm

ced

 

operatio

secure

 

autho

xtended

 

peri

ument

 

detai

ic

 

retail

 

paym

lication

 

Proc

k

 

will

 

accept

13.

  

ons

 

will

 

be

 

s

tage

 

1

 

 

Bus

tage

 

2

 

 

Ope

 

Business

 

A

 

Business

 

A

nical

 

expert

icant.

 

The

 

cr

ded

 

for

 

unde

.

Natur

.

Capita

.

Adequ

R

 

AUTHORIZ

Section

 

3

 

of

th

 

responsib

s

 

in

 

the

 

proc

ector.

 

The

 

G

d

 

published

which

 

the

 

Ba

e

 

of

 

the

 

Ban

ment

 

of

 

and

 

payment

 

ser

mencement

 

ons

 

prior

 

to

 

orization

 

fro

iod

 

that

 

the

 

ils

 

the

 

applic

ment

 

service

cess

 

t

 

completed

subjected

 

to

siness

 

Assess

erational

 

Ass

Assessment

 

Assessment

 

ise

 

and

 

the

 

riteria

 

for

 

Sta

er

 

the

 

Guide

re

 

and

 

scale

 

al

 

adequacy;

uate

 

Govern

ZATION

 ‐ 

EL

f

 

the

 

Payme

bility

 

for

 

Ove

cess

 

of

 

facilit

Guidelines

 

f

 

by

 

the

 

Ban

ank

 

will

 

adm

k

 

is

 

informe

demand

 

for

rvice

 

provide

of

 

operati

the

 

implem

om

 

the

 

Bank

Bank

 

may

 

d

cation

 

and

 

a

es.

 

 

application

o

 

a

 

two

 

stage

sment

 

sessment

  

involves

 

a

 

re

governance

 

age

 

1

‐ 

Busin

lines:

 

of

 

the

 

busin

;

 

nance

 

Arrang

ECTRONIC

 

R

nt

 

Clearing

 

ersight

 

of

 

the

tating

 

the

 

g

or

 

Electroni

nk

 

after

 

ext

minister

 

its

 

O

d

 

by

 

the

 

rap

innovative

 

p

ers

 

will

 

be

 

r

ons.

 

Electr

mentation

 

of

 

 

within

 

6

 

mo

etermine.

 

authorizatio

 

forms

 

alon

e

 

assessmen

eview

 

of

 

the

and

 

admini

ness

 

Assessm

ess;

 

gements;

 

RETAIL

 

PAYM

and

 

Settlem

e

 

National

 

Pa

rowth

 

and

 

d

ic

 

Retail

 

Pay

tensive

 

stak

Oversight

 

fun

pid

 

pace

 

of

 

t

payment

 

pro

required

 

to

 

onic

 

Retail

 

f

 

the

 

Guideli

onths

 

from

 

2

n

 

process

 

fo

g

 

with

 

the

 

r

nt

 

process,

 

i.e

e

 

business

 

p

strative

 

arra

ment

 

will

 

inc

MENT

 

SERVI

ment

 

Act,

 

20

ayment

 

Syst

developmen

yment

 

Serv

keholder

 

con

nction

 

in

 

re

technologica

oducts

 

and

 

s

secure

 

auth

Payment

 

nes

 

are

 

req

2

 

April

 

2013

 

or

 

applicants

required

 

info

e.:

 

plans,

 

financ

angements

 

t

clude

 

a

 

revie

CE

 

PROVIDE

010,

 

the

 

Ban

tem.

 

In

 

keep

nt

 

of

 

the

 

elec

ices

 

(Guidel

nsultations,

 

lation

 

to

 

ret

al

 

advancem

services.

   

horization

 

fro

Service

 

Pro

uired

 

to

 

tak

or

 

before

 

th

s

 

who

 

inten

ormation

 

co

cial

 

strength

that

 

will

 

be

 

e

ew

 

of

 

the

 

fol

ER

 

k

 

of

 

Jamaica

ping

 

with

 

thi

ctronic

 

retai

lines),

 

which

provide

 

the

tail

 

paymen

ent,

 

which

 

i

om

 

the

 

Ban

oviders

 

who

e

 

immediate

he

 

expiration

d

 

to

 

provide

ommencing

 

2

,

 

manageria

employed

 

by

lowing

 

area

a

 

s

 

il

 

h

 

e

 

t

 

s

 

k

 

o

 

e

 

n

 

e

 

2

 

al

 

y

 

s

 

(3)

3.2

 

 

3.3

4.

 

4.1

4.2

 

d

e

f.

g

h

As

 

part

 

presenta

Applican

arise

 

du

The

 

Bank

Stage

 

2

 

Assessme

confirme

 

Stage

 

2

 

Stage

 

2

 

operatio

the

 

appli

The

 

crite

are

 

as

 

fo

a

b

Additiona

process.

 

.

Outso

.

Use

 

o

Consu

.

Liquid

.

Eviden

of

 

Stage

 

1

 

ation

 

cover

nts

 

must

 

be

ring

 

the

 

pr

k

 

will

 

commu

 

Operation

ent,

 

the

 

suit

ed.

 

 

Operationa

 

Operation

ns

 

inclusive

 

cant’s

 

prima

eria

 

for

 

Sta

ollows:

 

.

Opera

i.

ii.

iii.

iv.

.

Inform

i.

ii.

iii.

al

 

informati

ourcing

 

Arran

f

 

Agents;

 

umer

 

protect

dity

 

Requirem

nce

 

of

 

funds

 

Business

 

ing

 

critical

 

e

 

prepared

 

esentation

unicate

 

the

 

r

nal

 

Assessm

ability

 

of

 

the

al

 

Assessme

nal

 

Assessm

of

 

the

 

infor

ary

 

location

 

age

 

2

 

 

Ope

ational

 

requi

Evidence

 

o

documenta

Rules,

 

proc

Evidence

 

of

Evidence

 

of

mation

 

Tech

Evidence

 

of

Measures

 

o

Systems

 

se

ion

 

and

 

doc

ngements;

 

tion;

 

ments;

 

s

 

manageme

Assessmen

componen

to

 

respond

.

 

 

results

 

of

 

th

ment

 

will

 

co

e

 

applicant

 

t

ent

 

ent

 

will

 

be

 

rmation

 

tech

and

 

operati

erational

 

A

irements

 

inc

f

 

service

 

be

ation

 

where

 

cedures,

 

poli

f

 

outsourcin

f

 

defined

 

ter

nology

 

Infra

f

 

systems

 

int

of

 

operation

curity

 

and

 

a

cumentation

ent;

 

and

 

AML

t,

 

applicant

nts

 

of

 

the

 

b

d

 

to

 

all

 

que

e

 

Stage

 

1

 

 

B

mmence

 

on

to

 

operate

 

th

administere

hnology

 

infra

onal

 

environ

Assessment

clusive

 

of:

 

ing

 

provided

relevant;

 

cies

 

and

 

oth

g

 

and/or

 

ag

rms

 

and

 

con

structure

 

re

teroperabilit

al

 

reliability

ccessibility.

n

 

may

 

be

 

re

L/CFT

 

proce

ts

 

will

 

be

 

re

business

 

an

eries

 

and

 

re

Business

 

Ass

nly

 

if,

 

on

 

th

he

 

proposed

ed

 

to

 

determ

astructure.

 

T

nment

 

in

 

gen

 

based

 

on

 

d

 

with

 

clear

her

 

contractu

ency

 

arrang

nditions

 

for

 

c

eview

 

inclusi

ty,

 

identifica

y,

 

business

 

co

equested

 

by

sses

 

and

 

pro

equired

 

to

 

d

 

the

 

oper

equests

 

for

sessment

 

to

he

 

basis

 

of

 

d

 

electronic

 

mine

 

the

 

ad

This

 

will

 

be

 

neral.

 

the

 

provis

r

 

identificatio

ual

 

or

 

opera

ements

 

and

customers,

 

a

ve

 

of:

 

ation

 

of

 

stan

ontingency

 

a

y

 

the

 

Bank

 

ocedures.

 

make

 

a

 

com

ational

 

arra

 

clarificatio

 

the

 

applica

the

 

Stage

 

1

retail

 

payme

dequacy

 

of

 

t

an

 

onsite

 

as

ions

 

in

 

the

on

 

of

 

custod

ational

 

proce

 

agreement

and

 

merchan

ndards

 

comp

arrangemen

during

 

the

mprehensive

angements

on

 

that

 

may

nt

 

in

 

writing

1

 

 

Busines

ent

 

service

 

i

the

 

busines

ssessment

 

o

e

 

Guideline

dian

 

accoun

edures;

 

s;

 

and

 

nts.

 

pliance;

 

nts;

 

and

 

 

assessmen

e

 

.

 

y

 

g.

 

s

 

s

 

s

 

f

 

s

 

t

 

t

 

(4)

5.

     

5.1

5.2

5.3

5.4

5.5

5.6

5.7

 

 

Direction

All

 

Appli

operating

All

 

quest

applicabl

If

 

the

 

ap

provided

Where

 

a

taken

 

as

 

Where

 

t

informat

containe

regard

 

to

Applican

The

 

time

a

b

c.

d

e

 

 

ns

 

for

 

Comp

ications

 

mu

g

 

entity.

 

tions

 

on

 

the

le

 

(N/A)

 

or

 

n

pplicant

 

is

 

u

d

 

in

 

the

 

cove

pplicants

 

are

confirmatio

he

 

space

 

p

ion

 

should

 

b

d

 

on

 

the

 

a

o

 

the

 

respon

ts

 

can

 

provid

eframe

 

for

 

au

.

The

 

co

.

The

 

co

.

The

 

ti

.

Any

 

fu

.

The

 

t

applic

leting

 

Appli

st

 

be

 

subm

e

 

applicatio

none

 

as

 

appr

unable

 

to

 

su

ring

 

letter

 

(w

e

 

required

 

to

n.

 

rovided

 

on

 

be

 

submitte

pplication

 

f

nses

 

provided

de

 

additiona

uthorization

omplexity

 

of

omplexity

 

of

me

 

taken

 

by

urther

 

chang

ime

 

taken

 

b

cation.

 

 

cation

 

Form

mitted

 

with

 

n

 

form

 

mus

ropriate.

 

Do

 

ubmit

 

any

 

o

with

 

referen

o

 

‘confirm’,

 

the

 

applica

ed

 

on

 

a

 

sepa

form.

 

Furthe

d)

 

for

 

the

 

pu

al

 

informatio

 

will

 

be

 

impa

f

 

the

 

applica

f

 

the

 

group

 

s

y

 

the

 

applica

ges

 

made

 

by

by

 

any

 

relev

m

 

a

 

covering

 

st

 

be

 

compl

not

 

leave

 

bl

of

 

the

 

requi

nce

 

to

 

the

 

sp

a

 

tick

 

()

 

pl

ation

 

form

 

arate

 

sheet

er

 

informati

urpose

 

of

 

co

on

 

that

 

may

 

acted

 

by:

 

ation;

 

structure

 

(if

 

ant

 

to

 

respon

y

 

the

 

applica

vant

 

third

 

p

letter

 

sign

leted.

 

If

 

a

 

q

lank

 

spaces.

red

 

docume

pecific

 

quest

laced

 

in

 

the

 

is

 

inadequa

with

 

the

 

ap

ion

 

or

 

clarif

nsidering

 

an

assist

 

with

 

t

applicable);

nd

 

to

 

querie

nt

 

during

 

th

party

 

to

 

res

ed

 

by

 

the

 

question

 

do

  

entation,

 

an

ion

 

number)

application

 

ate

 

for

 

the

 

ppropriate

 

r

fication

 

may

nd

 

assessing

the

 

assessm

;

 

es/clarificatio

he

 

authorizat

spond

 

to

 

qu

principal

 

of

es

 

not

 

appl

n

 

explanatio

).

 

confirmatio

response,

 

t

eference

 

to

y

 

be

 

reque

 

an

 

applicati

ent

 

process.

ons;

 

tion

 

process

ueries

 

in

 

rel

fficer

 

of

 

the

ly,

 

write

 

no

on

 

should

 

be

n

 

box

 

will

 

be

the

 

required

 

the

 

reques

sted

 

(having

ion.

 

.

 

s;

 

and

 

ation

 

to

 

the

e

 

t

 

e

 

e

 

d

 

t

 

g

 

e

 

(5)

AP Pursuant applicants otherwise 1 THE APP 1.1 Full le 1.2 Trade 1.3 Busin 1.4 Telep 1.5 Fax N 1.6 E-ma 1.7 Instit 1.8 Date 1.9 Comp 1.10 Type 1.11 Provid 1.12 Provid estab 1.13 Provid 2. CAPITA 2.1 Confirm Service 2.2 Confirm 2.3 Provide 3. GOVER Pursuant shall esta integrity include: 3.1 OWNE 3.1.1 Pro Atta PPLICATION F to Section s are require e requested b PLICANT egal name of a e name (if diffe ess Address: phone Number: Number: il Address: tution website of Incorporatio pany’s TRN: of Business: de a valid Tax Attached de a certified c blished and Cer Attached de a certified c Attached

AL

m that pursuan es, there is suf Yes m that evidence Attached e a capital man Attached NANCE to Section 7 ablish adequa of the operat ERSHIP AND M vide ownership ach a corporat Attached FOR AUTHORI 5 – Authoriz ed to submit by the Bank, t applicant (Com erent from 1.1) (if applicable): on: Compliance Ce copy of the Art rtificate of Inco

copy of the last nt to Section 6 fficient capital e of the requir nagement plan – Governanc ate governanc tions of its el MANAGEMENT p and organiza e organization

BANK O

IZATION - EL zation; of th

all the inform to inform the pany Name): ): : ertificate: Will follow icles of Associa orporation or B Will follow t audited finan Will follow - Capital Requ to support a m No ed net worth i Will follow . Will follow ce; of the Guid

ce arrangeme lectronic reta NT STRUCTURE tional informat chart). Will follow

OF JAMA

LECTRONIC R he Guidelines mation and d authorizatio ation or constit Business Regist cial statement irements; of th minimum net w s attached. delines for El ents, which a ail payment s E

tion (e.g. relat

AICA

ETAIL PAYME s for Electro documents, as n process. tuent documen tration in Jama (where applic he Guidelines f worth of USD10 lectronic Reta are effective a service. The g tionship to pare ENT SERVICE onic Retail P s outlined in nt under which aica: able): for Electronic R 00,000. tail Payment S and transpar governance a ent, holdings e PROVIDER Payment Serv the Guidelin the business i Retail Payment Services, an i rent, to ensur arrangements etc.) vices, nes or is t issuer re the s shall

(6)

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Fit and Prop

Personal Que of Jamaica’s Certified Pho Curriculum V The original The relevant MANAGEMEN relation to risk Risk Manag Appropriate risk and ensu Adequate r hardware, so consistent an An indepen electronic re ails of the polic er risks. Attached nal Audit an independen Yes s, provide deta Attached NESS CONTIN ide the details Attached EM SECURITY relation to syst System Sec Adequate an relevant risk Data is trans means owning, d a significant influ

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t internal audit ails of the arra NUITY PLAN of the busines Y AND INTEGR tem security an

curity and Int

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(7)

3 3.5.2 Ide 3.5.3 Do 3.5.4 Provi 4. OPERAT 4.1 Pursu is Co pa 1 2 3 4 4.2 Pro 4.3 List a Appropriate documented ntify the office

you intend to Yes ide a system se Attached TIONAL REQU uant to Sectio suers shall est onfirm whethe ayment service Operationa Rules and pr liabilities of services, a stakeholders Measures to the scheme, control proc whether inte Adequate arr Separate rec payment inst ovide a copy of Attached any other servic

systems secur and tested. ers responsible

secure the serv ecurity plan. UIREMENT n 8 - Operatio ablish appropr r there are ad e, which shall i l Requiremen rocedures sett f the issuer, gents, merch . ensure safety , including co cedures, to b rnal or outsou rangements to cords and acco

truments. f your operatio

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rity procedures

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vice of a third No Will follow onal Requireme iate operationa dequate operat nclude: nts

ing out the rig third parties hants, users , security and ntingency arra be applied to rced. ensure interop ounts for activi

nal plan. Will follow be offered: s have been d ng review of a party to condu ents; of the Gu al arrangement tional arrangem ghts, responsib s providing o and other operational re angements an o all relevant perability. ities related to developed, all IT arrangem uct security au uidelines for E ts. ments in place bilities and outsourced relevant eliability of d disaster t systems, o the retail

ment and freque

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for the propo

Yes ency of review il Payment Ser osed electronic No ws: rvices, c retail

(8)

4.4 Provid 4.5 If mu 4.6 Who 5. OUTSO 5.1 Pursu whet Risk 5.2 If ye outs 5.3 In rel 1 2 3 4 5 5.4 Pursu whether ag 5.5 If Yes 5.6 Provid de the followin a. A detai Att b. A detai The dia I. II. III. IV. c. A detai and eff Att ultiple products Att will be your cle

URCING AND

uant to Sectio her any impor Management/C es, indicate w sourcing arrang Att lation to the ou The outsour management The relation payment serv None of the authorization The outsourc in such a wa controls and the applican Guidelines. A service Le outsourced agreement(s uant to Section gents, branche s, provide infor Att de the followin a. A list w used in Att ng in relation to led description tached led flow diagra agram should i Flow of fund Clear identif Timing and d Payment me Yes il description o ficient delivery tached s will be provid tached earing and sett

USE OF AGEN on 10 – Outso rtant function Compliance will Yes which functions gements includ tached utsourcing of i

rcing will not t of its respons nship and obli vice users shal conditions (if n is granted sh cing of operat ay as to impair the ability of t’s compliance vel Agreement functions re ) is (are) attac 11 - Use of Ag s or other third Yes rmation on the tached ng for each age with the name n the provision tached o the issuance n of the electro Will fo am representin nclude: ds and informat ication of agen dependencies b dia (e.g. mobi of the establis of payment se Will fo ed, a separate Will fo tlement agent? NTS ourcing; of the of the electro l be outsourced s will be outso ding copies of t Will fo mportant opera result in th sibility. gations of th ll not be altere any) subject all be removed ional functions r the quality o f the competen e with all oblig t will be put in eferenced at ched. gents; of the G d parties will b e number and l Will Foll ent: es, addresses, of electronic r Will fo of electronic r onic retail paym

llow ng the electron tion transmitte nts and/or bran between payme le phone or ca No hed clearing a ervices. llow e diagram must llow ? Provide name e Guidelines f nic retail paym d to another en

No

ourced, the na the service leve

llow ational functio e delegation e applicant to ed. to which the d or modified. s will not be u f the applicant nt authorities t gations laid do n place in relat 5.2 and t Guidelines for E be appointed. No ocation of such ow TRN and cont retail payment llow retail payment ment service pr ic retail payme ed between pay nches or other ent flows; rd) and the sy and settlement t be provided f e and business for Electronic ment services ntity. ame of the op el agreements ns confirm tha by senior owards its applicant’s undertaken t’s internal to monitor own in the tion to the the draft Electronic Reta h entities : tact informatio services. services: rocess. ent transaction yer and payee; entity involved stem to be em

t arrangements

for each payme

details.

Retail Paymen e.g. I.T., fina

perator and pr where applica

at:

Yes

ail Payment Ser

on of the prin n process. ; d in the proces ployed; s to ensure th ent process. nt Services, co ance, Internal rovide details ble. No rvices, confirm cipal agent(s) ss; e safe onfirm Audit, of the to be

(9)

1 2 3 4 5 6. CONSU 6.1 Pursu Payment S 1 2 3 4 5 6 7 8 6.2 Provi electr 6.3 Prov 7 LIQUID 7.1 Pursu confi 7.2 Provid 7.3 Provide b. A desc with th (CFT). Att c. Criteria Att d. A copy and du e. Provide

Fit and Prop

Personal Que of Jamaica’s Certified Pho Curriculum V The original The relevant MER PROTEC uant to Section ervices, confirm Consumer P Protection of Consumer ed Privacy of cu Reliable and Transparency Prompt respo Refund dema Dispute reso de details of t ronic retail pay

Att ide details of t Att ITY uant to Section rm that the mi a. liquid previ b. liquid de financial pro Att e a liquidity ma ription of the e obligations i tached a for appointing tached of the agency ties and perfor e the fit and pr

per Requirem estionnaires (th website http:/ otograph Vitae receipt eviden fee for obtain

TION, EDUCA n 12 - Consum m whether ade Protection, Ed f customer fund ducation ustomer inform quality service y of product an onse to inquirie ands lution he methods th yment services tached the dispute res tached

13 - Liquidity nimum liquidit d funds of not ious six month

d funds of not Yes ojections and b tached anagement pla internal contro n relation to a Will fo g agents. Will fo y agreement, d rmance standa roper requirem ments

his may be dow //www.boj.org.

cing payment f ing FID Cleara

ATION AND PR mer Protection, equate measure ducation and ds ation es nd services es and complai

hat will be imp . Will fo solution arrang Will fo Requirement; y requirements

less than thre s) of amounts

less than six m udget for at le Will fo n. ol mechanisms nti-money laun llow llow detailing the ar rds of the agen ents as detaile wnloaded from .jm. for a Police Ce ance RIVACY Education and es are in place Privacy ints lemented to sa llow ements and re llow of the Guidelin s are in place a ee times the av required to se and months gross o No east three (3) y llow that will be u ndering (AML) rrangements to nt. ed below in res the Bank ertificate d Privacy; of t e to address the

afe guard the f

dress mechani

nes for Electro as detailed bel verage maximu ttle customer t operating expen years. used by agents and combattin o include the r spect of each a Attached the Guidelines e following: Yes funds which ar sms.

onic Retail Paym ow: um daily value transactions; nses. s in order to c ng terrorist fina ights responsib agent: Will fol for Electronic No re held in relat ment Services, (computed ov comply ancing bilities low Retail tion to er the

(10)

8 ANTI-M 8.1 Pursu Elect 1 2 3 8.2 Provid the E 9 COMPLI 9.1 In rel 1 2 The a Applic ONEY LAUND uant to Section ronic Retail Pa Anti-Money Adequate pro comply with guidelines ad Adequate pr third party relevant AML Appropriate maintain the reporting req de the Anti-mo Electronic Retai Att IANCE lation to compl Compliance The retail pa The relevant have been es applicant shoul

cation form and

DERING AND T 20 - Anti-Mon yment Services y Laundering ocedures are i AML/CFT pro dopted by the ocedures are acting on you L/CFT requirem processes and e relevant info quirements. oney laundering il Payment Serv tached

liance with sta

e ayment service a. The Bank b. Payment t reporting req stablished. d notify the Ba d in the enclos TERRORIST F ey Laundering s, confirm the and Terrorist n place to me ocedures, as w Bank to this en in place to en ur behalf act ments. procedures ar ormation and g/ Counter Fina vice. Will fo ted legislation offered are fu k of Jamaica Ac Clearing and S quirements to ank of Jamaica sed documents INANCING /Counter Finan following: t Financing et the require well as regula nd.

sure that any in compliance re in place to o to satisfy the ancing of Terro llow and regulatory lly compliant w ct Settlement Act the regulatory in writing of a which have oc ncing of Terror ments and ations and agents or e with the obtain and e AML/CFT orism Policies a y procedures, c with: y authority any changes in ccurred after s rism; of the Gu Yes and Procedure confirm the fo Yes the informatio submitting the uidelines for No s which will ap llowing: No on contained in application. pply to n the

(11)

Pleas Bank Paym 76 Kn Kings Jamai For q The D Paym Bank 76 Kn Kings Jamai Telep E-mai I declare t and belief, Senior Offi Signature: Senior Offi Signature: Designated Signature: Affix comp se return form of Jamaica ent System De nutsford Boulev ton 5 ica questions, ple Director ent System De of Jamaica nutsford Boulev ton 5 ica hone: (876) 92 il: payment.sys

hat all stateme true and comp cer: cer: d Officer: any seal: m and suppor epartment vard ease contact: epartment vard 22-0750-9 exte [email protected] ents made in th plete statemen rting documen ension 6100-1 jm his application nts. nts to:

and the attach

Position Date: Position Date: Position Date: hed documents n: n: n:

References

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