Bank of Namibia - FinTech Application Form

Summary

Find out more about FinTech Application Form.

FinTech Application Form

Name of Applicant (Individual or Company):

Company Registration Number:

Upload Company Registration Document:

Certificate of Good Standing:

Website Address:

Name of Key Contact Person(s) (e.g., CEO or COO) Kindly attach CVs and police clearance certificates.:

Upload CV and Police Clearance Certificates:

Applicant’s Physical Address:

Applicant’s Email Address:

Mobile Phone Number :

Upload Shareholder Supporting Documents:

Describe the nature of your business and operations (attach comprehensive business plan):

Upload Business Plan:

Briefly describe the FinTech Solution and how it relates to the provision of financial services (include comprehensive description in business plan):

Briefly describe the underlying technologies and infrastructure of the proposed innovation (include comprehensive description in business plan):

Please provide any other information that may be relevant to your application:

Name of FinTech Innovation:

Is the FinTech Innovation currently being offered in other jurisdictions? (If yes, list jurisdictions):

Upload License / Authorization from other domestic Authorities (attached proof):

Identify the type of customers or customer segments targeted by your FinTech innovation:

Indicate and explain whether the FinTech innovation involves the holding or transferring of customer funds:

If applicable, indicate current agreements entered into with third parties including local and foreign financial institutions and other stakeholders (attach all third-party agreements) :

Upload all third-party agreements:

Upload Financial projection for the proposed FinTech innovation (provide proforma statements):

Upload evidence of resources enabling participation in the Regulatory Programme (financial, infrastructure, assets etc.) :

Describe and attach the business strategy and plan include the roadmap to deploy the proposed FinTech innovation on a broader scale after exiting the Programme:

Upload file Business Strategy and Plan:

Identify any existing laws and regulations that are incompatible with the proposed FinTech innovation, and the desired regulatory flexibilities needed under the Programme:

Indicate the source of funding (both present and future arrangements) for the development and deployment of the FinTech innovation:

Describe your proposed exit strategy in the event of discontinuation at any time or after the Programme has lapsed:

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FinTech Application Form

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FinTech Application Form

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