Notification Form of Registered Person Resignation or Dismissal

As per the notification requirement stipulated in Annex (3.2) clause (10) point (3) of the Authorized Persons Regulations (APR) in relation to registered persons resignation or dismissal, the authorized person must notify the CMA immediately by filling out this form and submit it with the supported documents to the Authorization department via the Registration e-mail (Registration@cma.org.sa).

(Table of Contents)

Section (1)	Registered person info
Section (2)	Notification info

Authorized Person's Name

Registered Person's Name

Date:

Day	Month	Year

Section 1: Registered Person's Information

1.1 Full Name (Arabic):

اسم العائلة	اسم الجد	اسم الأب	الاسم الأول

Full Name (English):

First Name	Middle Name	Grandfather Name	Surname

Nationality:

National ID Number for Saudis or GCC Citizens:

Passport Number for Non-Saudis:

Residence Permit number

Job title (Arabic)

CEO or Managing Director

Finance Officer

Director Or Partner

Compliance Officer

MLRO

Senior officer or manager (Please state the Job title below):

Current job title (Arabic)

Section 2: Notification Information:

Notification Type

Resignation

Dismissal

Date of resignation / dismissal submission

Day	Month	Year

In case of dismissal, (Please state in details the dismissal reasons below and attach the supporting documents)

Note: Please attach this form with a copy of confirmation of receiving notification of resignation or dismissal from CMA when you apply for a cancellation of registration of the person at the "ECM Portal of APs".

Name of the authorized signatory	Position

_______________________________________

Signature

Date:

Day	Month	Year