APPOINTED REPRESENTATIVE COMPANY APPLICATION FORM 2023

APPOINTED REPRESENTATIVE COMPANY APPLICATION FORM

Company Name (for this application) *

Company Legal Status *

When was the company formed? *

Any additional trading styles currently used or to be used (e.g. "Trading as…")

All trading styles must be registered

Do you trade from a different address to registered address?

Yes
No

Full Company REGISTERED Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

As per Companies House

Full Company TRADING Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Sole traders without a company address should add their home address

Company Telephone Number *

(Sole traders without a separate number should use their personal details)

Company Email *

Company Website

Do you have a Data Protection Licence for this company?

Yes
Will be provided at a later time

What is your Data Protection Number?

____________________________________________________________

1. Has the COMPANY ever had any of the following?

Been removed (all staff) from a lender or providers panel?

Yes
No

More information

Please provide full details including an explanation of what happened and the current status.

Been late with any submissions to companies house resulting in a striking off notice?

Yes
No

More information

Please provide full details including an explanation of what happened and the current status.

Been subject to any debt proceedings resulting in a county court judgment?

Yes
No

More information

Please provide full details including an explanation of what happened and the current status.

Been suspended or terminated by a Network or the FCA?

Yes
No

More information

Please provide full details including an explanation of what happened and the current status.

____________________________________________________________

2. Your Limited Company

Is it a new company?

Yes, number will be provided later
Not new

Limited Company number

Is the company owned or to be owned by another company or is part of a group*?

Yes
No

Please provide details and provide a group structure chart and any Group company FCA numbers

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3. Existing and Authorised status

Does the company have a current or past FCA number?

Yes
No

FCA Number

Directly Authorised or Network Member?

Directly Authorised
Network Member

What is the name of the Network?

Please provide further details about the authorised status, e.g. why the change of status and why you are seeking new/additional network membership with Connect.

Which of the following regulated permissions do you plan to continue under the existing authorisation if applicable?

Regulated Mortgages
Insurance Distribution
Consumer Credit including Broking
Consumer BTL
Pensions and/or Investments
other...

You selected 'other', please provide more info.

Please confirm the expected turnover (£) for the next 12 months for the business that will continue under the existing authorisation.

____________________________________________________________

4. Business Plan

Please confirm ALL the planned business activities for this entity, and whether the business type will be transacted under the Connect approval and agencies (Sole traders need to include all the activities they do that are not done through a separate limited company or other legal entity).

-RM

Residential Mortgages (RM)

Yes
No

Projected Gross Income (£)

% of Business

To be transacted under Connect agencies?

Yes
No

-PP

Personal Projection Plans (PP)

Yes
No

Projected Gross Income (£)

% of Business

To be transacted under Connect agencies?

Yes
No

-GI

General Insurance Plans - Buildings & Contents (GI)

Yes
No

Projected Gross Income (£)

% of Business

To be transacted under Connect agencies?

Yes
No

-ER

Equity Release Mortgages (ER)

Yes
No

Projected Gross Income (£)

% of Business

To be transacted under Connect agencies?

Yes
No

-CB

Consumer Buy-to-Let - Accidental Landlords (CB)

Yes
No

Projected Gross Income (£)

% of Business

To be transacted under Connect agencies?

Yes
No

-CC

Business Buy-to-Let (CC)

Yes
No

Projected Gross Income (£)

% of Business

To be transacted under Connect agencies?

Yes
No

-CC

Commercial Mortgages (CC)

Yes
No

Projected Gross Income (£)

% of Business

To be transacted under Connect agencies?

Yes
No

-RM

Residential Bridge Loans (RM)

Yes
No

Projected Gross Income (£)

% of Business

To be transacted under Connect agencies?

Yes
No

-CC

Buy-to-Let Commercial Bridge Loans (CC)

Yes
No

Projected Gross Income (£)

% of Business

To be transacted under Connect agencies?

Yes
No

-RM

Residential Second Charges (RM)

Yes
No

Projected Gross Income (£)

% of Business

To be transacted under Connect agencies?

Yes
No

-CC

Buy-to-Let Second Charges (CC)

Yes
No

Projected Gross Income (£)

% of Business

To be transacted under Connect agencies?

Yes
No

-CC

Unsecured Business Loans

Yes
No

Projected Gross Income (£)

% of Business

To be transacted under Connect agencies?

Yes
No

-CC

Referrals of Commercial Loans to Third Parties (CC)

Yes
No

Projected Gross Income (£)

% of Business

To be transacted under Connect agencies?

Yes
No

-CC

Asset or Invoice Finance (CC)

Yes
No

Projected Gross Income (£)

% of Business

To be transacted under Connect agencies?

Yes
No

-FN

Any Sales to Foreign Nationals not Located in the UK (FN)

Yes
No

Projected Gross Income (£)

% of Business

To be transacted under Connect agencies?

Yes
No

-TOTALS

TOTALS:

TOTAL PROJECTED GROSS INCOME (£)

TOTAL % of Business

Must add up to 100%

____________________________________________________________

5. Permissions

Based on the expected business above, please confirm which permission categories you would like the company to be authorised for so that advisers with the relevant qualifications can receive permission to give advice on that product once they have passed their training.

Consumer Credit (CC)

Yes
No

Residential Mortgages

Yes
No

Must hold the mortgage qualification and also hold Consumer Credit permission.

Personal Protection Plans

Yes
No

Must hold at least one other permission.

Equity Release

Yes
No

Must hold the ER qualification and also hold Residential Mortgages permission.

Foreign Nationals

Yes
No

Must also hold Consumer Credit permission.

General Insurance

Yes
No

Included at no cost with any other permission taken.

The monthly cost is £50 per month for each permission for the first adviser and £25 per month for each permission for each adviser thereafter.

____________________________________________________________

6. Other Financial Business

Does the company currently, or plan in the next 12 months, to conduct any of the following types of financial business outside of the Connect arrangement?

Selling of funeral plans

Yes
No

Structured deposit regulated activity.

Yes
No

Operating an electronic system in relation to lending.

Yes
No

Selling of Private Medical Insurance.

Yes
No

Lending money or banking for consumers.

Yes
No

Property-related collective investment schemes.

Yes
No

Bidding in emissions auctions.

Yes
No

Property sale and rent back.

Yes
No

Home purchase plan sales HPP (Sharia).

Yes
No

Home reversion plans.

Yes
No

Lending money or banking for businesses.

Yes
No

Foreign exchange services.

Yes
No

Payment services or credit services institution.

Yes
No

Electronic money institution.

Yes
No

Cryptocurrency sales or transactions.

Yes
No

Issuing of securities or other services of a corporate finance nature.

Yes
No

Accountancy services.

Yes
No

Will writing (not referrals) or estate planning and trust advice.

Yes
No

Custodial and deposit services.

Yes
No

Financial leasing or money transmission or payment services.

Yes
No

Financial information and data services or financial guarantees.

Yes
No

Non-regulated pensions or investment services.

Yes
No

Any other services of a financial related nature.

Yes
No

Please provide details of your other services.

Please confirm the expected turnover for the next 12 months for the selected business of a financial nature as above (£).

____________________________________________________________

7. Other Non-Financial Business

Does the company currently, or plan in the next 12 months, to conduct any types of business of a non-regulated and non-financial nature outside of the Connect arrangement?

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Estate or Letting Agency

Yes
No

Other Property Sales or Advice

Yes
No

Legal Services

Yes
No

Consultancy

Yes
No

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Other...

Yes
No

Please provide details of your other services.

Please confirm the expected turnover for the next 12 months for the selected business of a non-regulated and non-financial nature as above.

____________________________________________________________

8. Conflicts of Interest

Please confirm how you will manage any conflicts of interest between any business the company will be granted permission by Connect IFA Ltd to transact and any other regulated or non-regulated business the company will be transacting outside of the Connect arrangement.

____________________________________________________________

9. Generating Business

Please provide full details of how the business will generate leads for its advisers, for example, adverts, website, purchased leads, introducers etc. Include detail such as the number and frequency of leads needed, the cost of generating the leads and if you are working with introducers, any commission or incentives you will pay introducers.

____________________________________________________________

10. Introducers

Who do you currently, or whom do you have planned that will introduce clients to the business?

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Individual's Name

Company Name

Type of Introducer

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Individual's Name

Company Name

Type of Introducer

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Individual's Name

Company Name

Type of Introducer

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Individual's Name

Company Name

Type of Introducer

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Individual's Name

Company Name

Type of Introducer

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Individual's Name

Company Name

Type of Introducer

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Individual's Name

Company Name

Type of Introducer

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Individual's Name

Company Name

Type of Introducer

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Individual's Name

Company Name

Type of Introducer

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Individual's Name

Company Name

Type of Introducer

____________________________________________________________

11. Business Cashflow

Please provide detail of what funds will be needed to start the business under Connect. For example, premises, staff, purchase of leads, income cashflow etc. Then confirm where you expect the funds to come from, e.g. Own or director funds, loans, existing income etc.

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Amount needed

Item required

Amount of available funds

Funding source

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Amount needed

Item required

Amount of available funds

Funding source

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____________________________________________________________

12. Individuals Involved in the Business

Please list everyone who works in the business including admin staff and non-advising shareholders and directors. Please list the main controller first.

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Name *

First

Last

Shareholder?

Main Controller or Owner?

Main Controller or Owner?

Company Director?

Company Director?

Is this person involved in the day-to-day business running?

Is this person involved in the day-to-day business running?

Will this person manage others?

Will this person manage others?

Does this person require permission to advise?

Does this person require permission to advise?

Does this person have an admin or other role?

Does this person have an admin or other role?

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Name

First

Last

Shareholder?

Main Controller or Owner? (copy)

Main Controller or Owner?

Company Director? (copy)

Company Director?

Is this person involved in the day-to-day business running? (copy)

Is this person involved in the day-to-day business running?

Will this person manage others? (copy)

Will this person manage others?

Does this person require permission to advise? (copy)

Does this person require permission to advise?

Does this person have an admin or other role? (copy)

Does this person have an admin or other role?

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Name

First

Last

Shareholder?

Main Controller or Owner? (copy)

Main Controller or Owner?

Company Director? (copy)

Company Director?

Is this person involved in the day-to-day business running? (copy)

Is this person involved in the day-to-day business running?

Will this person manage others? (copy)

Will this person manage others?

Does this person require permission to advise? (copy)

Does this person require permission to advise?

Does this person have an admin or other role? (copy)

Does this person have an admin or other role?

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Name

First

Last

Shareholder?

Main Controller or Owner? (copy)

Main Controller or Owner?

Company Director? (copy)

Company Director?

Is this person involved in the day-to-day business running? (copy)

Is this person involved in the day-to-day business running?

Will this person manage others? (copy)

Will this person manage others?

Does this person require permission to advise? (copy)

Does this person require permission to advise?

Does this person have an admin or other role? (copy)

Does this person have an admin or other role?

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Name

First

Last

Shareholder?

Main Controller or Owner? (copy)

Main Controller or Owner?

Company Director? (copy)

Company Director?

Is this person involved in the day-to-day business running? (copy)

Is this person involved in the day-to-day business running?

Will this person manage others? (copy)

Will this person manage others?

Does this person require permission to advise? (copy)

Does this person require permission to advise?

Does this person have an admin or other role? (copy)

Does this person have an admin or other role?

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Name

First

Last

Shareholder?

Main Controller or Owner? (copy)

Main Controller or Owner?

Company Director? (copy)

Company Director?

Is this person involved in the day-to-day business running? (copy)

Is this person involved in the day-to-day business running?

Will this person manage others? (copy)

Will this person manage others?

Does this person require permission to advise? (copy)

Does this person require permission to advise?

Does this person have an admin or other role? (copy)

Does this person have an admin or other role?

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Name

First

Last

Shareholder?

Main Controller or Owner? (copy)

Main Controller or Owner?

Company Director? (copy)

Company Director?

Is this person involved in the day-to-day business running? (copy)

Is this person involved in the day-to-day business running?

Will this person manage others? (copy)

Will this person manage others?

Does this person require permission to advise? (copy)

Does this person require permission to advise?

Does this person have an admin or other role? (copy)

Does this person have an admin or other role?

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Name

First

Last

Shareholder?

Main Controller or Owner? (copy)

Main Controller or Owner?

Company Director? (copy)

Company Director?

Is this person involved in the day-to-day business running? (copy)

Is this person involved in the day-to-day business running?

Will this person manage others? (copy)

Will this person manage others?

Does this person require permission to advise? (copy)

Does this person require permission to advise?

Does this person have an admin or other role? (copy)

Does this person have an admin or other role?

Layout (copy)

Name

First

Last

Shareholder?

Main Controller or Owner? (copy)

Main Controller or Owner?

Company Director? (copy)

Company Director?

Is this person involved in the day-to-day business running? (copy)

Is this person involved in the day-to-day business running?

Will this person manage others? (copy)

Will this person manage others?

Does this person require permission to advise? (copy)

Does this person require permission to advise?

Does this person have an admin or other role? (copy)

Does this person have an admin or other role?

Layout (copy)

Name

First

Last

Shareholder?

Main Controller or Owner? (copy)

Main Controller or Owner?

Company Director? (copy)

Company Director?

Is this person involved in the day-to-day business running? (copy)

Is this person involved in the day-to-day business running?

Will this person manage others? (copy)

Will this person manage others?

Does this person require permission to advise? (copy)

Does this person require permission to advise?

Does this person have an admin or other role? (copy)

Does this person have an admin or other role?

____________________________________________________________

13. Consultants

Please list any consultants you have for the business including any temporary or long-term consultants, business and compliance consultants and also any non-executive directors.

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Individual's Name

Company Name

Role

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Individual's Name (copy)

Company Name (copy)

Role (copy)

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Individual's Name (copy)

Company Name (copy)

Role (copy)

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Individual's Name (copy)

Company Name (copy)

Role (copy)

____________________________________________________________

14. Plans for Growth

Please provide detail of any of the plans for the growth of the company.

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Next 12 months:

Number and type of additional staff

Introducers/leads/business development

Other, e.g. office location, product permission changes etc

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1 to 3 years:

Number and type of additional staff (copy)

Introducers/leads/business development (copy)

Other, e.g. office location, product permission changes etc (copy)

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3 to 5 years:

Number and type of additional staff (copy)

Introducers/leads/business development (copy)

Other, e.g. office location, product permission changes etc (copy)

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5 years plus:

Number and type of additional staff (copy)

Introducers/leads/business development (copy)

Other, e.g. office location, product permission changes etc (copy)

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15. Individual Application Forms

Each individual listed above should now complete the following form depending on their role:

Role	Form to Complete
The Main Controller	Main Controller Application Form (MCFV1122)
A ltd company director requiring permission to advise	Secondary Controller Application Form (SCFV1122)
A ltd company director not giving client advice but is involved in the management of staff or the day-to-day business running	Secondary Controller Application Form (SCFV1122)
A non-advising shareholder with a higher % of shares than the main controller	Secondary Controller Application Form (SCFV1122)
All other directors or shareholders not requiring permission to advise	Non-Advising Controller Form (NAC1122)
All other staff requiring permission to give client advice	Adviser Application Form (AAF1122)
All other staff not requiring permission to advise	Administrator Application Form (ADF1122)
Consultants (Where you wish the consultant to liaise with Connect)	Administrator Application Form (ADF1122)

IMPORTANT NOTE
In relation to sections 12 and 13 above, it is a contractual condition of membership that all staff in the company are registered even if they are not active in the parts of the business you plan to transact under the Connect Agencies. Please ensure all staff at the point of application are disclosed and that any new additions or changes are notified.

The company and the main controller will need to be registered and approved by the FCA before any business can commence. All secondary controllers will also be registered with the FCA. Please also note, the application fee includes the FCA fee for the company and all the controller’s applications submitted to the FCA at the same time. Should the main or secondary controller need to be submitted at a different time, the FCA will charge £250 per additional application.

____________________________________________________________

16. Additional Notes

Paragraph Text

____________________________________________________________

17. Main Controller Company Declaration

WARNING: This information will be used to submit your details to the FCA for authorisation. Knowingly or recklessly giving the FCA information, which is false or misleading in a material particular, may be a criminal offence (sections 398 and 400 of the Financial Services and Markets Act 2000). SUP 15.6.4R requires an authorised person to take reasonable steps to ensure the accuracy and completeness of the information given to the FCA and to notify the FCA immediately if materially inaccurate information has been provided. Contravention of these requirements may lead to disciplinary sanctions or other enforcement action by the Appropriate Regulator. It should not be assumed that information is known to the FCA merely because it is in the public domain or has previously been disclosed to the FCA or another regulatory body. If you are not sure whether a piece of information is relevant, please include it anyway

I confirm that I wish to apply for this company to be an Appointed Representative of Connect IFA Ltd. I can confirm that as the main controller of this business, I have the appropriate authorisation to make this application on behalf of the company and its personnel.
I confirm that this information is accurate and complete to the best of my knowledge and belief and that I have taken all reasonable steps to ensure that this is the case.
I am aware that it is a criminal offence knowingly or recklessly to give the FCA information that is false or misleading in a material particular.
I will notify Connect immediately if there is a significant change to the information given in the form. If I fail to do so, this may result in a delay in the application process or enforcement action by the FCA.
I agree to Connect IFA Ltd, making any enquiries deemed necessary to verify the information in this application. I consent to any companies or organisations that the company is, or has been, associated with to provide this information if requested.
I confirm that I have disclosed everyone that is involved in the business and will be supplying a relevant individual application form for myself and all other personnel disclosed.

Main Controller *

First

Last

Date *

Signature *

On behalf of (Company Name) *