CRA Registered Person Cancellation Application

(Cancelling a Registration)

TABLE OF CONTENTS

As a requirement for individual registration, this application form must be completed and submitted with all required documents and attachments to the Authorization Department at the CMA

Section 1	AUTHORISED CRA AND CONTACT PERSON DETAILS
Section 2	REGISTERED PERSON INFORMATION
Section 3	CANCELLING A REGISTRATION

Registered Person Full Name (Arabic)

Registered Person Full Name (English)

Section 1: Authorised CRA and Contact Person Details

Authorised CRA Details

Name
License Number
Address
Website
E-mail Address
Telephone Number
Facsimile Number

Contact Person Details

Full Name
Job Title
Address
E-mail Address
Telephone Number
Mobile Number

Section 2: Registered Person Information

Full Name (Arabic):

اسم العائلة	اسم الجد	اسم الأب	الأسم الأول

Full Name (English):

First Name	Middle Name	Grandfather Name	Surname

Nationality:

National ID Number for Saudis and GCC Citizens:

Passport Number for Non-Saudis:

Residence Permit number

Current Job Title (Arabic)

Current Job Title (English)

Section 3: Cancelling a Registration

Cancellation Date/Last Day of Employment

Day	Month	Year

Reason(s) for Requesting the Cancellation

Please specify the reason:

Resignation:

Yes	No

If yes, provide the resignation letter

Dismissal

Yes	No

If yes, provide details with supporting documents:

Other, please specify:

Notification requirement:

Did the Authorised CRA notified the CMA in writing on the occurrence of the resignation or dismissal of the registered persons:

Yes	No

If yes, provide the notification letter

.

Name of the authorised CRA

_____________________________________________

Name of the registered person in writing

/ /

Signature	Date

.

Name of the Director/Responsible Officer in writing

/ /

Signature	Date