Psd individual Form Notes



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(NOTES) 1  Regulatory business plan

 

FCA 



 PSD Individual Notes 

 Release 7 



 May 2018 

page 1 

 

 

PSD Individual Form - Notes 

 

Application Form for an individual responsible for the 

management of a Payment Institution 

 

 

 

 

 

 



 

 

 



 

Notes to help complete the PSD Individual Form for an individual responsible for 

the management of a small Payment Institution (SPI) or authorised Payment 

Institution (API). 

More information on the factors which the FCA takes into account when considering 

applications, is in the ’Assessing fitness and propriety‘ section, Chapter 3 (Authorisation and 

Registration) of the Payment Services and Electronic Money -Our Approach Document . 

When completing the application forms you will need to refer to the Handbook: 

https://www.handbook.fca.org.uk/handbook/

  

 

If you need more help after reading these notes: 



 

check our website  



 

consult the Handbook: 



https://www.handbook.fca.org.uk/handbook/

    


 

call the Customer Contact Centre: 0300 500 0597  



 

email the Customer Contact Centre: 



Firm.Queries@fca.org.uk

  

These notes are to help you. They do not replace the rules and guidance in the Handbook. 



Purpose of this form 

The following are examples of persons required to complete and submit a PSD Individual form: 

 

all the members of the management board - for example, all the directors (if the 



applicant is a company), or the members (if the applicant is an LLP) 

 



all the management staff (except any who are not directly responsible for the 

payment services activity, for example, we would not expect a procurement 

manager whose responsibility is limited to sourcing and purchasing goods and 

services for the applicant to seek approval as a PSD Individual)  

 

all other persons with responsibility for the management of the firm’s payment 



services  

The firm is the applicant for the purposes of the PSD Individual form. The person whom the form is 

about is the PSD Individual. This should be the name that is recorded on the front cover of the PSD 

Individual Form (‘Name of individual‘).  



Terms in these notes 

These notes use the following terms: 

 

'you' refers to the person(s) signing the form on behalf of the applicant firm  



 

'the applicant firm' refers to the firm applying for authorisation  



 

‘the FCA' ,'we', ‘us’ or 'our' refers to the Financial Conduct Authority  



 

FSMA refers to the Financial Services and Markets Act 2000  



 


1   (NOTES) Personal identification details 

 

FCA 


 PSD Individual Notes 

 Release 7 



 May 2018 

page 2 

 

 

 

 

 

 

 



 

 

 



Important information 

The PSD Individual form is of the utmost importance to our assessment of the fitness and propriety of 

the individual. 

You must send us all relevant information with the PSD Individual form. This applies even if: 

 

you believe the information is, or may be, already known to the FCA, as a result of it 



being in the public domain, or has been previously disclosed to us or to another 

regulatory body  

 

the information is considered to be immaterial  



You should not assume that information is known to the FCA because it is in the public domain, or has 

been previously disclosed to the FCA, or to another regulatory body. The applicant cannot assume 

that the FCA will check its existing records in assessing this application in respect of (or for 

information relating to) the applicant or persons connected to it.  In all circumstances, disclosures 

should be full, frank and unambiguous. If there is any doubt about the relevance of information, it 

should be included; if in doubt, disclose it. The information supplied by the individual should be 

verified by the firm making the application wherever possible. If the FCA's vetting checks reveal any 

matters that have not been disclosed, applications will be delayed and, in some cases, may be 

rejected.  

We may require the applicant to provide further information at any time after receiving an application. 

If the form is not fully and correctly completed, we may need to return it for proper completion. This 

could significantly delay the FCA's decision. 

The firm is responsible for the accuracy of the data and completion of the form.  

If a firm has provided, or has information that reasonably suggests that it may have 

provided, the FCA with information which was or has become false, misleading, incomplete 

or inaccurate, in a material particular, it must notify the FCA immediately. Failure to notify 

the FCA may result in a delay in processing, or rejection of, the application. 

 

Key considerations for the firm and the individual 

You should be aware that since the 21 July 2011, the law has changed. By virtue of the Rehabilitation 

of Offenders Act 1974 (Exceptions) Order 1975 and the Rehabilitation of Offenders (Exceptions) Order 

(Northern Ireland) 1979 as amended, if the individual is subject to the law of England, Wales or 

Northern Ireland, they must disclose spent convictions and spent cautions.  We have the ability to 

require the disclosure of any spent convictions and cautions you have for the purpose of determining 

whether the Applicant meets the conditions for Authorisation or Registration.  

The principles for determining whether or not a conviction/caution is spent are set out in the 

Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 and the Rehabilitation of Offenders 

(Exceptions) Order (Northern Ireland) 1979 as amended.  

The law relating to the rehabilitation of offenders is complex.  You may wish to ask for legal help if 

you consider that you have a conviction or caution that does not need to be disclosed because it is 

spent and the law of England, Wales or Northern Ireland does not apply.  If in doubt we would 

suggest that you disclose any convictions or cautions. 

The FCA processes personal data in line with the requirements of The General Data Protection 

Regulation (EU) 2016/679 and the Data Protection Act 2018. For further information about the way 

we use the personal data collected in this form, please read our privacy notice available on our 

website: 

www.fca.org.uk/privacy

 . 

 



1   (NOTES) Personal identification details 

 

FCA 


 PSD Individual Notes 

 Release 7 



 May 2018 

page 3 

 

 



If at any time after an applicant has provided the FCA with any information and before the FCA has 

determined the application there is, or there is likely to be, a material change affecting any matter 

contained in that information or it becomes apparent to the applicant that the information is 

incomplete or contains material inaccuracy, the applicant must provide the FCA with details of the 

change, the complete information or a correction of the inaccuracy without undue delay or as soon as 

the applicant is aware of such change. 

We rely on the information contained in the PSD Individual form in making our assessment. It is very 

important that the individual and the applicant (ie the applicant for authorised or registered PI status) 

are aware of: 

 

1. the factors which we take into account when considering the fitness and propriety of the 



individual which are set out in the ‘Assessing reputation – fitness and propriety’ section in 

Chapter 3 (Authorisation and Registration) of the Approach Document  

 

2. these guidance notes. The applicant (ie the applicant for authorised or registered PI 



status) and the PSD Individual should have read and understood these guidance notes 

before completing the PSD Individual form  

 

3. the fact that responsibility for the accuracy and completeness of the information supplied 



rests with the PSD Individual and the firm. Seeking legal or compliance advice about how to 

complete the PSD Individual form will not discharge that responsibility. In particular, if 

advice is sought on whether a particular matter falls to be disclosed in Section 5 (‘Fitness 

and propriety’), we will expect a disclosure to be made as the requirement for advice 

indicates doubt on the matter. If there is doubt, disclose. 

 

 



Contents of these notes 

1  Personal identification details 

2  Firm identical details 



3  Arrangements 

4  Employment history 



5  Fitness and Propriety 

6  Supplementary information 



15 

7  Declarations and signatures 

16 

 

 




1   (NOTES) Personal identification details 

 

FCA 


 PSD Individual Notes 

 Release 7 



 May 2018 

page 4 

 

 





 

Personal identification details 

 

 



If the individual has more than one previous name (surname or forenames), 

passport number or nationality, or is known by any other names, provide 

details in Section 6.  

  1.1  FCA Individual Reference Number (IRN) (if individual is already 

registered with the FCA) 

If the individual does not have an FCA Individual Reference Number (IRN) or 

does not know it, include the name of the previous regulator and the 

previous PSD Individual Reference Number, as applicable. 



  1.2  Title (eg Mr, Mrs, Ms, etc) 

No additional notes 



  1.3  Surname 

No additional notes 



  1.4  ALL forenames 

No additional notes 



  1.5  Name commonly known by 

If the individual is commonly known by a different name other than that 

which appears on their passport or National Insurance card, then put this 

name here. This may include, for example, a shortened version of their full 

name or where they are known by a middle name or names given as a result 

of naming conventions, whether for religious or other reasons. If the 

individual has more than one alternative name, please give all other names 

known by in Section 6. 



  1.6  Previous name 

If the individual has changed their name (surname or forenames), for 

example due to marriage, then please put this previous name in the box. If 

the individual has more than one previous name, please provide details of all 

the previous names in Section 6. 

  1.7  Date of name change (dd/mm/yyyy) 

No additional notes 



  1.8  Gender 

No additional notes 



  1.9  Date of birth (dd/mm/yyyy) 

No additional notes 



1.10  Place of birth 

No additional notes 

 



1   (NOTES) Personal identification details 

 

FCA 


 PSD Individual Notes 

 Release 7 



 May 2018 

page 5 

1.11  National Insurance number or copy of passport (or equivalent) 

No additional notes 



1.12  Nationality 

If the individual has more than one nationality, please provide details in 

Section 6 as to all nationalities held and the reasons for this. 

1.13/1.14  Private address 

A full 3 year history for United Kingdom addresses must be given for the 

individual. Any gaps must be fully explained or a statement provided in either 

the address history or Section 6 of the form. If any gaps are as a result of the 

individual being resident outside the UK, please state this and give details of 

where the individual resided during this period. It is open to the individual to 

provide a written statement if this is simpler, which should be attached to the 

PSD Individual form. 

 

 



2 (NOTES)  Firm identification details 

 

FCA 


 PSD Individual Notes 

 Release 7 



 May 2018 

page 6 



Firm identification details 

 

  2.1  Name of applicant firm (or individual if sole trader) making the 

application 

No additional notes 



  2.2  FCA Firm Reference Number (FRN) 

No additional notes 



  2.3  Who should the FCA contact at the applicant firm in relation to this 

application? 

The firm must indicate a point of contact for any queries in connection with 

the application and must provide a telephone contact number and email 

address. 

 

 



3 (NOTES)  Arrangements 

 

FCA 


 PSD Individual Notes 

 Release 7 



 May 2018 

page 7 



Arrangements 

 

  3.1  Details of position to be held by the PSD Individual  

The firm must tick the box in 3.1 that most accurately describes the position 

to be held by the individual. 

3.2    Please attach the following (as applicable) 

In most cases we expect to receive the individual’s employment contract. 

Where this is not available, please supply another form of confirmation of 

employment, such as a letter of appointment or offer for the role.  



3.3    When is the individuals planned start date? 

No additional notes 



3.4    Does the role have an expected end date? 

No additional notes 



3.5    What are the individual’s key duties and responsibilities? 

This should include a summary of the role as set out in the contract of 

employment (or other job description), as well as information about any 

specific projects or tasks which the individual anticipates being involved in.  



 

 

 


4   (NOTES) Employment history and qualifications 

 

FCA 


 PSD Individual Notes 

 Release 7 



 May 2018 

page 8 



Employment history and qualifications 

 

Employment details 

4.1 and 4.2 

A full five-year employment history for the individual must be provided 

including their current employment at the time of application, with all gaps 

explained. If the record of employment does not go back five years, all 

periods of education and unemployment must be indicated. Full details of any 

periods of self-employment must be included. 

Always give the address of the actual place of employment, rather than a 

central head office. 

If there are insufficient pages to provide all of an individual's employment 

history, either add the information at Section 6 or photocopy page 7 and 

attach the additional pages. Alternatively, further detail about past roles can 

be provided in the individual’s CV, which we require under Question 4.3 

’Regulatory body‘ in this context means the bodies listed in the notes to 

Section 5 (overleaf). 

State the position held by the individual and a brief explanation of his or her 

duties. If the individual’s job title included the word ’director‘ but his or her 

duties did not include those associated with the title of director, this should 

be indicated. 

The reason for leaving each employer must be given. If there were any 

issues arising on leaving that could affect the Fitness and Propriety of the 

individual, these must be fully explained in Section 6. We may contact 

previous employers, and the omission of relevant details may result in 

applications being delayed and, in some cases, possibly rejected. 

4.3    Please attach an up-to-date CV containing details of education and 

professional experience. This must include academic qualifications,   

relevant training, the name and nature of all organisations for which 

the individual works or has worked, and the nature and duration of 

the functions performed. It should highlight any activities within the 

scope of the position sought. 

Where the individual has given only brief details about past employment 

under question 4.1, the CV can be used as a means to expand and explain 

past roles in detail.   



  4.4  Where applicable, please include information on the suitability 

assessment carried out by the applicant. This should include details 

of the result of any assessment of the suitability of the individual 

performed by the applicant, such as relevant board minutes or 

suitability assessment reports or other documents 

Where the applicant firm has carried out a suitability assessment in relation 

to the PSD Individual, please attach this. This could comprise a formal report 

on the individual’s suitability for the role, or may include results of discrete 

assessments carried out in relation to the individual, such as case studies 

and records of interview performance.   

 



5 (NOTES)  Fitness and Propriety 

FCA 


 PSD Individual Notes 

 Release 7 



 May 2018 

page 9 



Fitness and Propriety 

 

 

Answer the question by ticking the relevant ‘yes’ or ‘no’ box. If the answer to 



any of the questions is ‘yes’, give complete details in Section 6 and attach 

relevant supporting documentation. 

Terms used: 

 



Criminal proceedings – includes any proceedings from the point at 

which an individual or a firm is charged with a criminal offence to the 

point at which sentence is given. 

 



Conviction – includes any absolute or conditional discharge orders made 

against the person concerned. 

 

Judgement debt – a court judgment or order requiring a payment of 



money to be made by the PSD Individual or by a firm at which the PSD 

Individual previously held a position of significant influence. 

 

Authorisation – includes any authorisation, licence, registration, 



approval, notification, membership or relevant permission required to 

carry on any activity. This need not be an activity regulated by the FCA 

but applies to all activities requiring some kind of authorisation. 

 



Position of responsibility – includes acting as a controller, director, 

senior manager, managing member, designated member, partner 

company secretary, or otherwise performing a role of similar influence or 

responsibility. 

 

Regulated activities – includes not only activities regulated by the FCA 



under FSMA, but also the Payment Services Regulations 2017 and 

Electronic Money Regulations 2011. It also includes activities regulated 

by other regulatory bodies (see definition of regulatory body below) 

 



Regulatory body – For the purposes of this form, a regulatory body 

includes but is not limited to the following: 

 

a self-regulatory organisation – including Investment Management 



Regulatory Organisation (IMRO), Securities and Futures Agency 

(SFA), Personal Investment Authority (PIA), Life Assurance and Unit 

Trust Regulatory Organisation (LAUTRO), Financial Intermediaries, 

Managers and Brokers Regulatory Association (FIMBRA), Association 

of Futures Brokers and Dealers Limited (AFBD), The Securities 

Association Limited (TSA);  

 

a statutory body, including the Financial Conduct Authority (FCA), 



Prudential Regulatory Authority (PRA), Financial Services Authority 

(FSA), Securities and Investments Board (SIB), the Society of 

Lloyd's, the Registry of Friendly Societies, the Friendly Societies 

Commission, the Building Societies Commission, the Bank of 

England, HMRC, the Treasury – Insurance Directorate (formerly the 

DTI) and the recognised bodies 

 

the National Crime Agency or the Serious Fraud Organisation (SFO) 



or any police body 

 



a designated professional body (a professional body designated by 

the Treasury under section 326A of the Financial Services and 

Markets Act 2000)  

 



the equivalent of any of these regulatory bodies overseas. 

 



5 (NOTES)  Fitness and Propriety 

FCA 


 PSD Individual Notes 

 Release 7 



 May 2018 

page 10 

Part A – Criminal proceedings 

Questions 5.1 to 5.4 deal with any matters relating to criminal investigations 

(any matters up to and including arrest up to the point of charge), criminal 

proceedings (any matters from charge up to and including sentencing) and 

criminal convictions. 

 

Where the answer to any of the questions is ‘Yes’, full details must be 



provided in Section 6 and on additional sheets attached to the PSD Individual 

form where necessary. It is important that we have all the details relating to 

the particular matter in the PSD Individual form. Complete and accurate 

details should be provided even if the information is already known to the 

FCA or it is in the public domain. 

5.1  i  Has the PSD Individual ever been convicted of any criminal 

offence? (You should include any conviction of an offence for 

which the PSD Individual received an absolute or conditional 

discharge. You should include traffic offences only if they resulted 

in a ban from driving or involved driving without insurance). 

This question requires disclosure of any criminal convictions. They should be 

disclosed even if the conviction was overseas. As stated in the form, you 

should include any conviction of an offence for which the PSD Individual 

received an absolute or conditional discharge.  

  ii  Is the PSD Individual currently the subject of any pending criminal 

investigation?  

No additional notes 



5.2  i  Is the PSD Individual currently the subject of any proceedings 

relating to any criminal offence?

  

This question requires disclosure of any criminal investigations that are 



ongoing at the point at which the application form is completed.  For 

example, this might include where the individual has been interviewed about 

a criminal offence or where their home or office has been searched. Any such 

matters should be disclosed, even if the individual has not been arrested or 

charged and, in their own view, is unlikely to be arrested or charged. 

  ii  Has the PSD Individual ever been the subject of any proceedings 

or investigations relating to any criminal offence? 

No additional notes 



  iii  Where such documents can be obtained, you must attach an 

official certificate or equivalent document (such as evidence of 

third party investigations and testimonies) detailing any criminal 

matter or, where applicable, evidencing the absence of such 

matters (eg a Disclosure and Barring Service (DBS) Certificate or 

any other similar document). 

No additional notes 



5.3  Has any organisation entity at which the PSD Individual holds or 

has held a position of responsibility ever been involved as a debtor 

in insolvency or comparable proceedings? 

No additional notes 



5.4  If you have answered yes to any of the questions in Part A above, 

please give full details in Section 6. Tick this box to confirm that 

you have provided full details, including reason(s), date(s) and 

duration as applicable. 

No additional notes 




5 (NOTES)  Fitness and Propriety 

FCA 


 PSD Individual Notes 

 Release 7 



 May 2018 

page 11 

Part B – Civil proceedings and administrative proceedings 

This section relates to civil disputes and litigation, including those that have 

resulted in the PSD Individual (or a firm at which they held a position of 

significant responsibility) being required by the court to pay money to 

someone. 

The FCA will conduct credit checks. 



5.5  Has the PSD Individual ever been: 

  i  the subject of any civil or administrative investigations or 

proceedings?  

No additional notes 



  ii  subject to civil or administrative decisions that were found against 

them? (You should include, for example, injunctions and 

employment tribunal proceedings.) 

No additional notes 



  iii  the subject of any civil or administrative enforcement 

proceedings, sanctions or other enforcement decisions? 

No additional notes 

 

  iv  directly or indirectly involved in any investigation, enforcement 

proceedings or sanctions by a supervisory authority? 

No additional notes 



5.6  Where such documents can be obtained, you must attach an 

official certificate or equivalent document (such as evidence of 

third party investigations and testimonies) detailing whether or 

not the civil or administrative matters detailed above have 

occurred in respect of the PSD individual. 

No additional notes 



  5.7  Has the PSD Individual ever (tick all that apply) 

i-iii; 

These questions cover all circumstances in which anyone started bankruptcy 

proceedings (or, in Scotland, called ‘sequestration’ of the individual’s estate) 

in relation to the PSD Individual. It also includes circumstances where the 

PSD Individual began such proceedings. 

  iv  made any arrangements with creditors, for example a deed of 

arrangement or an individual voluntary arrangement (or in 

Scotland a trust deed);  

This requires disclosure of any voluntary agreement which the individual has 

already entered into with anyone to whom they owe money. This includes 

informal arrangements with creditors, and debt consolidation services. This 

could include where alternative mortgage arrangements have been made. It 

could also include more formal arrangements such as an ‘individual voluntary 

arrangement’ - whether or not these arrangements were entered into after 

advice from a debt management adviser. 



  v  had assets sequestrated; or 

No additional notes 



  vi  been involved in any proceeding relating to the above matters 

even if such proceedings did not result in the making of any kind 

of order or result in any kind of agreement? 

It is irrelevant whether or not any of the matters in 5.7 i - v actually resulted 

in the making of an order, they must still be disclosed. 



5 (NOTES)  Fitness and Propriety 

FCA 


 PSD Individual Notes 

 Release 7 



 May 2018 

page 12 

5.8  Is the PSD Individual currently involved in any proceedings in 

relation to any of the matters set out in Questions 5.7(i) – (vi) 

above (you should include where the PSD Individual is in the 

process of entering into any kind of agreement in favour of the 

PSD Individual's creditors)? 

This question requires disclosure of circumstances in which the individual has 

a voluntary agreement with someone about paying off a debt or is in ongoing 

bankruptcy proceedings. For example, this would include any ongoing 

discussions with the mortgage lender and any discussions with creditors 

about payments of debts. 



5.9  Does the PSD Individual have any outstanding financial 

obligations connected with regulated activities (including any 

activities regulated by the FCA or any other regulatory body), 

which the PSD Individual has carried on in the past? 

This requires disclosure of any other historical financial matters which might 

impact upon the current financial circumstances of the individual. For 

example, claims for clawback being made by a former employer should be 

disclosed here. 

5.10 If you have answered yes to any of the questions in Part B above 

please give full details in Section 6. Tick this box to confirm that 

you have provided full details, including reason(s), date(s) and 

duration as applicable as well as supporting documents. 

No additional notes 



Part C – Business and employment matters 

These questions relate to roles the PSD Individual has previously performed, 

whether that role was related to the provision of a regulated activity or not. 

It should also be noted that these questions are not limited to   previous 

roles listed in Section 4 of the PSD Individual form. They matter whenever 

they occurred, at any time. Relevant disclosures are expected, even if the 

PSD Individual was not actually being paid a salary. 

5.11 Has the PSD Individual ever been: 

  i  dismissed; 

  ii  asked to resign; or 

  iii  suspended 

    from any profession, vocation, office, employment, position of 

trust, fiduciary appointment or similar, whether or not 

remunerated?  

Do not include any redundancies or temporary roles which have come to an 

end at the expiry of the employment contract.   

5.12 Has the PSD Individual ever been: 

  i  disqualified from acting as a director or similar position? 

No additional notes 



  ii  the subject of any proceedings of a disciplinary nature (whether 

or not the proceedings resulted in any finding)? 

This question includes where the proceedings or internal investigations by a 

current or a previous employer have yet to be concluded. 



5 (NOTES)  Fitness and Propriety 

FCA 


 PSD Individual Notes 

 Release 7 



 May 2018 

page 13 

  iii  the subject of any investigation which might lead to or might have 

led to disciplinary proceedings? 

This question includes where the proceedings or internal investigations by a 

current or a previous employer have yet to be concluded. 

  iv  notified of any potential proceedings of a disciplinary nature? 

No additional notes 



  v  the subject of any allegations of malpractice or misconduct in 

connection with any business activities? 

No additional notes 



5.13 If you have answered yes to any of the questions in Part C above, 

please give full details in Section 6. This at a minimum should 

include the reason(s), date(s) and duration as applicable, 

alongside supporting documents. Tick this box confirm that you 

have provided full details: 

No additional notes 

In Section 6 of the form  full details must be provided if there were any 

issues that could affect the fitness and propriety of the individual that arose 

when leaving an employer listed in Section 4. 

Part D – Regulatory matters 

These questions are not limited to activities regulated by the FCA and are not 

limited to investigations by or matters involving a regulatory or industry 

body. 


Where there is a reference to a regulatory body in the question, this should 

be interpreted widely. Answers should include, for example, activities 

supervised by overseas financial regulators, or other types of regulators such 

as government or statutory bodies( UK or overseas). If in doubt as to 

whether something should be included in this section, the information should 

be disclosed. 



5.14  Has the PSD Individual ever: 

  i  been refused, had revoked or terminated, any authorisation, 

registration, membership or licence to carry out a trade, business 

or a profession? 

No additional notes 



  ii  been excluded by a competent authority or public sector entity in 

the financial services sector or by a professional body or 

association (including, for example, any disbarment, dismissal or 

expulsion)? 

No additional notes 



5.15 Has an assessment of reputation of the PSD individual (as a 

person who directs the business of an institution) already been 

conducted by another competent authority (either within or 

outside of the financial sector)? 

No additional notes 



5.16 If you have answered yes to any of the questions in Part D above, 

please give full details in Section 6. This at a minimum should 

include the reason(s), date(s) and duration as applicable. Tick this 

box confirm that you have provided full details with supporting 

documents. 

No additional notes 




 6  (NOTES) Supplementary information

 

 



FCA 

 PSD Individual Notes 



 Release 7 

 May 2018 



page 14 



Supplementary information 

 

6.1  If there is any other information the individual or the firm 

considers may be relevant to the application, it must be 

included here. 

Please also include here any additional information indicated in 

previous sections of the Form. 

If there is insufficient space, please continue on a separate sheet of 

paper and clearly identify the section and question to which the 

additional information relates. 

This section provides space for any additional information. It should 

be used to disclose additional information about ’yes‘ answers in 

Section 5 of the Form. It should also be used for information which 

is not the subject of a specific question in Section 5, but is relevant 

to the consideration of fitness and propriety.  

More information on the factors which the FCA takes into account 

when considering applications is in the ’Assessing fitness and 

propriety‘ section in Chapter 3 (Authorisation and Registration) of 

Our Approach document entitled Payment Services and Electronic 

Money – Our Approach. You can find this on the Payment Services 

section of the FCA website: 

www.fca.org.uk

  

Relevant documents must also be provided, such as evidence of the 



settlements of County Court Judgments. 

 


 7  (NOTES) Declarations and signatures 

FCA 


 PSD Individual Notes 

 Release 7 



 May 2018 

page 15 

Declarations and signatures 



 

 

This section contains declarations which must be signed by both an 



appropriate individual for the firm or applicant submitting the application and 

the individual.  

Signatures must not be dated more than 3 months prior to the date of 

submission of the application.  

The FCA considers that an appropriate individual would either be an 

individual responsible for the management of a small or authorised Payment 

Institution, or someone to whom the firm has delegated the authority to 

notify the FCA.  

 

If this authority has been delegated, the firm should keep records of those 



individuals authorised to sign on behalf of the applicant (ie the applicant for 

authorised or registered PI status).  



 

Document Outline

  • Notes to help complete the PSD Individual Form for an individual responsible for the management of a small Payment Institution (SPI) or authorised Payment Institution (API).
  • More information on the factors which the FCA takes into account when considering applications, is in the ’Assessing fitness and propriety‘ section, Chapter 3 (Authorisation and Registration) of the Payment Services and Electronic Money -Our Approach ...
  • When completing the application forms you will need to refer to the Handbook: https://www.handbook.fca.org.uk/handbook/
  • If you need more help after reading these notes:
  •  check our website
  •  consult the Handbook: https://www.handbook.fca.org.uk/handbook/
  •  call the Customer Contact Centre: 0300 500 0597
  •  email the Customer Contact Centre: Firm.Queries@fca.org.uk
  •  all the members of the management board - for example, all the directors (if the applicant is a company), or the members (if the applicant is an LLP)
  •  all the management staff (except any who are not directly responsible for the payment services activity, for example, we would not expect a procurement manager whose responsibility is limited to sourcing and purchasing goods and services for the app...
  •  all other persons with responsibility for the management of the firm’s payment services
  •  you believe the information is, or may be, already known to the FCA, as a result of it being in the public domain, or has been previously disclosed to us or to another regulatory body
  •  the information is considered to be immaterial
  • 1. the factors which we take into account when considering the fitness and propriety of the individual which are set out in the ‘Assessing reputation – fitness and propriety’ section in Chapter 3 (Authorisation and Registration) of the Approach Document
  • 2. these guidance notes. The applicant (ie the applicant for authorised or registered PI status) and the PSD Individual should have read and understood these guidance notes before completing the PSD Individual form
  • 3. the fact that responsibility for the accuracy and completeness of the information supplied rests with the PSD Individual and the firm. Seeking legal or compliance advice about how to complete the PSD Individual form will not discharge that responsi...
  • 1.1 FCA Individual Reference Number (IRN) (if individual is already registered with the FCA)
  • 1.2 Title (eg Mr, Mrs, Ms, etc)
  • 1.3 Surname
  • 1.4 ALL forenames
  • 1.5 Name commonly known by
  • 1.6 Previous name
  • 1.7 Date of name change (dd/mm/yyyy)
  • 1.8 Gender
  • 1.9 Date of birth (dd/mm/yyyy)
  • 1.10 Place of birth
  • 1.11 National Insurance number or copy of passport (or equivalent)
  • 1.12 Nationality
  • 1.13/1.14 Private address
  • 2.1 Name of applicant firm (or individual if sole trader) making the application
  • 2.2 FCA Firm Reference Number (FRN)
  • 2.3 Who should the FCA contact at the applicant firm in relation to this application?
  • 3.1 Details of position to be held by the PSD Individual
  • 3.2  Please attach the following (as applicable)
  • 3.3  When is the individuals planned start date?
  • 3.4  Does the role have an expected end date?
  • 3.5  What are the individual’s key duties and responsibilities?
    • Employment details
  • 4.1 and 4.2
  • 4.3  Please attach an up-to-date CV containing details of education and professional experience. This must include academic qualifications,   relevant training, the name and nature of all organisations for which the individual works or has worked, and...
  • 4.4 Where applicable, please include information on the suitability assessment carried out by the applicant. This should include details of the result of any assessment of the suitability of the individual performed by the applicant, such as relevan...
    • Part A – Criminal proceedings
  • 5.1 i Has the PSD Individual ever been convicted of any criminal offence? (You should include any conviction of an offence for which the PSD Individual received an absolute or conditional discharge. You should include traffic offences only if they re...
  • ii Is the PSD Individual currently the subject of any pending criminal investigation?
  • 5.2 i Is the PSD Individual currently the subject of any proceedings relating to any criminal offence?
  • ii Has the PSD Individual ever been the subject of any proceedings or investigations relating to any criminal offence?
  • iii Where such documents can be obtained, you must attach an official certificate or equivalent document (such as evidence of third party investigations and testimonies) detailing any criminal matter or, where applicable, evidencing the absence of su...
  • 5.3 Has any organisation entity at which the PSD Individual holds or has held a position of responsibility ever been involved as a debtor in insolvency or comparable proceedings?
  • 5.4 If you have answered yes to any of the questions in Part A above, please give full details in Section 6. Tick this box to confirm that you have provided full details, including reason(s), date(s) and duration as applicable.
    • Part B – Civil proceedings and administrative proceedings
  • 5.5 Has the PSD Individual ever been:
  • i the subject of any civil or administrative investigations or proceedings?
  • No additional notes
  • ii  subject to civil or administrative decisions that were found against them? (You should include, for example, injunctions and employment tribunal proceedings.)
  • No additional notes
  • iii the subject of any civil or administrative enforcement proceedings, sanctions or other enforcement decisions?
  • No additional notes
  • iv directly or indirectly involved in any investigation, enforcement proceedings or sanctions by a supervisory authority?
  • No additional notes
  • 5.6 Where such documents can be obtained, you must attach an official certificate or equivalent document (such as evidence of third party investigations and testimonies) detailing whether or not the civil or administrative matters detailed above have...
  • 5.7 Has the PSD Individual ever (tick all that apply)
  • i-iii;
  • iv  made any arrangements with creditors, for example a deed of arrangement or an individual voluntary arrangement (or in Scotland a trust deed);
  • v  had assets sequestrated; or
  • vi  been involved in any proceeding relating to the above matters even if such proceedings did not result in the making of any kind of order or result in any kind of agreement?
  • 5.8 Is the PSD Individual currently involved in any proceedings in relation to any of the matters set out in Questions 5.7(i) – (vi) above (you should include where the PSD Individual is in the process of entering into any kind of agreement in favour ...
  • 5.9 Does the PSD Individual have any outstanding financial obligations connected with regulated activities (including any activities regulated by the FCA or any other regulatory body), which the PSD Individual has carried on in the past?
  • 5.10 If you have answered yes to any of the questions in Part B above please give full details in Section 6. Tick this box to confirm that you have provided full details, including reason(s), date(s) and duration as applicable as well as supporting do...
    • Part C – Business and employment matters
  • 5.11 Has the PSD Individual ever been:
  • i  dismissed;
  • ii  asked to resign; or
  • iii  suspended
  • from any profession, vocation, office, employment, position of trust, fiduciary appointment or similar, whether or not remunerated?
  • 5.12 Has the PSD Individual ever been:
  • i  disqualified from acting as a director or similar position?
  • ii  the subject of any proceedings of a disciplinary nature (whether or not the proceedings resulted in any finding)?
  • iii  the subject of any investigation which might lead to or might have led to disciplinary proceedings?
  • iv notified of any potential proceedings of a disciplinary nature?
  • v the subject of any allegations of malpractice or misconduct in connection with any business activities?
  • 5.13 If you have answered yes to any of the questions in Part C above, please give full details in Section 6. This at a minimum should include the reason(s), date(s) and duration as applicable, alongside supporting documents. Tick this box confirm tha...
    • Part D – Regulatory matters
  • 5.14 Has the PSD Individual ever:
  • i  been refused, had revoked or terminated, any authorisation, registration, membership or licence to carry out a trade, business or a profession?
  • ii  been excluded by a competent authority or public sector entity in the financial services sector or by a professional body or association (including, for example, any disbarment, dismissal or expulsion)?
  • 5.15 Has an assessment of reputation of the PSD individual (as a person who directs the business of an institution) already been conducted by another competent authority (either within or outside of the financial sector)?
  • 5.16 If you have answered yes to any of the questions in Part D above, please give full details in Section 6. This at a minimum should include the reason(s), date(s) and duration as applicable. Tick this box confirm that you have provided full details...
  • 6.1 If there is any other information the individual or the firm considers may be relevant to the application, it must be included here.

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