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CONFIDENTIAL

The Financial Intelligence Act No.13 of 2012 requires all Accountable and Reporting
entities to register their particulars with the centre for the purpose of supervising
compliance with this Act. We request your good office to complete the information
below for registration purpose. The completed form must be emailed to
amlinspections@namfisa.com.na once your institution is registered the confirmation will
be sent to your Anti Money Laundering Compliance Officer.

Details of the Anti-Money Laundering Compliance Officer


Title:
First name:
Surname:
ID number:
Email:
Occupation:
Cell:

Details of the Institution


Name of entity:
Company/Trust
registration number:
Type of business:
Physical address:
Town:
Phone:
Fax:

Should you have any queries, please do not hesitate to contact NAMFISA at (061) 290
5223/ 5258/ 5257/ 5255/ 5108.

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