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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