Company Service Providers

Notification Form

© MFSA, 06/04/2021

Details of the Notifier

Notification being made by:

Name of the notifier:

Full name (including identification document or company registration number):

Click or tap here to enter text.

Date when the notifier started providing company services by way of business:

Date:	Click or tap here to enter text.

Registered Address:

Address Line 1:	Click or tap here to enter text.

Address Line 2:	Click or tap here to enter text.

Town:	Click or tap here to enter text.

Country:	Click or tap here to enter text.

Post code:	Click or tap here to enter text.

Correspondence Address:

Address Line 1:	Click or tap here to enter text.

Address Line 2:	Click or tap here to enter text.

Town:	Click or tap here to enter text.

Country:	Click or tap here to enter text.

Post code:	Click or tap here to enter text.

Contact Details:

Telephone number:	Click or tap here to enter text.

Mobile Number:	Click or tap here to enter text.

Email address:	Click or tap here to enter text.

Website:	Click or tap here to enter text.

Notification

I/we hereby notify the Malta Financial Services Authority (MFSA) that I am/we are acting as a company service provider by way of business, and that I am/we are not required to apply for authorisation with the Authority in terms of the Company Service Providers Act (Chapter 529 of the laws of Malta).

Name and Surname:	Click or tap here to enter text.

Designation (if applicable):	Click or tap here to enter text.

Signature:

Date:	Click or tap here to enter text.

Kindly note that the notification will only be considered as valid if all the salient fields are completed and if the form is duly signed by the individual or, in the case of an entity, an authorised representative.

Completed forms should be submitted by email on fiduciariesoffsite@mfsa.mt and in original by mail, addressed to:

Conduct Supervision, MFSA

Triq l-Imdina, Zone 1,

Central Business District, Birkirkara, CBD 1010, Malta