COMPANY CONTROLLER APPLICATION FORM (CAF V1122)

Company Controller Application Form (CAF V1122) v5

FCA Controller Application - Please complete all sections fully and accurately.

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COMPANY CONTROLLER APPLICATION FORM (CAF V1122)

Please complete all sections fully. This form is required for FCA regulatory purposes.

Company Name

Are you the main controller for this company?

About you...

Title

Mr
Miss
Mrs
Dr
Other

If Other, please state

Name

First

Last

Name commonly known by / Nickname

Date of Birth

Mobile number

Landline number

Email address

National Insurance Number

If you were known by a previous name, enter it here.

Date of name change.

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1. ADDRESS HISTORY

Please provide a minimum of 5 years of address history with the current address listed first.

Address

Please fill in all the address fields

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date moved in

Click "Add" to add a previous address, or click "Save and Continue" to proceed...

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2. QUALIFICATIONS AND PRODUCT PERMISSIONS

Mortgage and protection qualifications, if applicable

e.g. CeMAP, MAQ, CeRER, ER1, etc.

Other non-industry qualifications

Do you personally plan to also give mortgage advice to clients?

3. PRODUCT PERMISSIONS & EXPERIENCE

Please indicate which services you can advise on and your level of experience...

Residential Mortgages [RM]

Residential mortgages - Do you want permissions to transact?

Residential mortgages - Level of experience

Very experienced
Some experience
No experience

Personal protection plans (Life/CIC/IP etc) [PP]

Personal protection plans - Do you want permissions to transact?

Personal protection plans - Level of experience

Very experienced
Some experience
No experience

General insurance plans (buildings and contents) [GI]

General insurance plans - Do you want permissions to transact?

General insurance plans - Level of experience

Very experienced
Some experience
No experience

Equity release mortgages [ER]

Equity release mortgages - Do you want permissions to transact?

Equity release mortgages - Level of experience

Very experienced
Some experience
No experience

Consumer Buy-to-Let (Accidental landlords) [CB]

Consumer Buy-to-Let - Do you want permissions to transact?

Consumer Buy-to-Let - Level of experience

Very experienced
Some experience
No experience

Business Buy-to-Let [CC]

Business Buy-to-Let - Do you want permissions to transact?

Business Buy-to-Let - Level of experience

Very experienced
Some experience
No experience

Commercial Mortgages [CC]

Commercial mortgages - Do you want permissions to transact?

Commercial mortgages - Level of experience

Very experienced
Some experience
No experience

Residential Bridge Loans [RM]

Residential bridge loans - Do you want permissions to transact?

Residential bridge loans - Level of experience

Very experienced
Some experience
No experience

Buy-to-Let Commercial Bridge Loans [CC]

Buy-to-Let commercial bridge loans - Do you want permissions to transact?

Buy-to-Let commercial bridge loans - Level of experience

Very experienced
Some experience
No experience

Residential second charges [RM]

Residential second charges - Do you want permissions to transact?

Residential second charges - Level of experience

Very experienced
Some experience
No experience

Buy to let second charges [CC]

Buy to let second charges - Do you want permissions to transact?

Buy to let second charges - Level of experience

Very experienced
Some experience
No experience

Unsecured Business loans [CC]

Unsecured Business loans - Do you want permissions to transact?

Unsecured Business loans - Level of experience

Very experienced
Some experience
No experience

Referrals of commercial loans to third parties [CC]

Referrals of commercial loans to third parties - Do you want permissions to transact?

Referrals of commercial loans to third parties - Level of experience

Very experienced
Some experience
No experience

Asset or Invoice finance [CC]

Asset or Invoice finance - Do you want permissions to transact?

Asset or Invoice finance - Level of experience

Very experienced
Some experience
No experience

Any sales to foreign nationals not located in the UK [FN]

Any sales to foreign nationals not located in the UK - Do you want permissions to transact?

Any sales to foreign nationals not located in the UK - Level of experience

Very experienced
Some experience
No experience

Note: Products highlighted in red in the original form (ER, FN, CC) require specific permissions.

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4. TRAINING & COMPETENT ADVISER STATUS

Complete this section if you plan to give advice.

Please detail any Mortgage or Protection training undertaken in the last 12 months

Do you have Competent Adviser Status (CAS)?

If yes, state date CAS achieved

Date

Time

To transfer your CAS status please provide the following:

CAS certificate or email confirmation from previous network
A copy of last 12 months CPD record
Your compliance or Audit records if available

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5. PROVIDER HISTORY

Have you personally or any company you have been involved in ever been REMOVED from a lender's or providers' panel?

If yes, please provide the provider details and more information

Have you personally or any company you have been involved in ever been DECLINED an agency or any type of account with a lender or provider?

If yes, please provide the provider details and more information

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6. COMPLAINTS

In the last 5 years, have you had any complaints about advice given or sales made in relation to a mortgage, loan or protection sale? (include regulated and non-regulated sales)

Have you had any complaints in the last 5 years?

Complaint Details

Date of complaint

Date

Time

Was this a regulated sale?

Details of complaint

Was the complaint upheld?

Amount of compensation (£)

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7. PROFESSIONAL INDEMNITY INSURANCE CLAIMS

Have you ever made a claim on any professional indemnity insurance in relation to a mortgage, loan or protection sale?

If yes, confirm which complaint above or provide more information

Do you have any outstanding liabilities with any organisation such as unpaid membership fees or protection liability of unearned commissions?

If yes, please provide full details

Have any insurers ever declined to offer insurance, imposed any special terms or cancelled/voided an insurance policy for yourself or any Firm where you were the Proposer, Partner, Principal or Director?

If yes, please provide full details

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8. BUSINESS SKILLS

Please provide details of how you have developed the skills needed to be authorised as the controller of an FCA-regulated business

Include any management-related and general business skills and any training undertaken.

How will you personally manage any growth plans detailed in the company application form?

What percentage of your working week do you expect to work in this business?

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9. EMPLOYMENT HISTORY

Please supply the contact details of your last 10 years of employment with the most recent first. We will need to take a reference for each employment so please ensure the contact details are accurate. If you were running your own business, please supply a professional referee such as your bank or accountant.

Employment History

Start with your most recent or current employment.

Company name

Position held

Job status

Employed
Self-employed
Other

Company FCA number (enter N/A if not authorised)

Detail any regulatory responsibilities held if applicable

Job description

Detail any management responsibilities held if applicable

Date from

Date

Time

Date until (leave blank if current)

Date

Time

Reason for leaving

Resignation
Redundancy
Retirement
Termination/Dismissal
End of contract
Other
N/A - Still employed

Contact name for reference

Contact job title

Contact number

Contact email

Current employment reference preference

I am happy for you to request this immediately
Please wait until I advise it is ok to request this

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10. GAPS IN EMPLOYMENT

All gaps in employment over the last 10 years must be explained.

Gap Details

Date from

Date

Time

Date until

Date

Time

Reason for gap

Can you supply evidence to support the reason?

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11. OTHER REGULATED ROLES

Were you in any other roles where you were authorised by the FCA either as an Approved Person, Directly Authorised or as an Appointed Representative more than 10 years ago?

If yes, please provide the details and FCA reference numbers

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12. OTHER BUSINESS INTERESTS

In the last 10 years, are you currently, or have you been, a director or shareholder or held any other role or have any business interest for any other business not included in the employment section? (Do not include the business that will be under the authorisation of Connect)

Do you have other business interests?

Other Business Details

Company name

Type of business

Job title

Company number

Is the company still trading?

Approximate annual turnover

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13. OTHER BUSINESS TYPES

Have you personally ever, or are you currently, involved in any of the following types of business?

Selling of funeral plans

Structured deposit regulated activity

Operating an electronic system in relation to lending

Selling of Private Medical Insurance

Lending money or banking for consumers

Property-related collective investment schemes

Bidding in emissions auctions

Property Sale and rentback

Home purchase plan sales HPP (Sharia)

Home Reversion Plans

Lending money or banking for businesses

Foreign exchange services

Payment services or credit services institution

Electronic money institution

Cryptocurrency sales or transactions

Issuing of securities or other services of a corporate finance nature

Accountancy services

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

Custodial and deposit services

Financial leasing or money transmission or payment services

Financial information and data services or financial guarantees

Non-regulated pensions or investment services

Any other services of a financial related nature

If the answer to any of the above is yes, please provide details in the Additional Information section.

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14. REGULATORY DISCLOSURES

[Add FCA Disclosure Note here]

6.1 - Criminal Proceedings

6.1.1a) Has the candidate ever been convicted of any criminal offence (whether spent or not and whether or not in the UK) involving fraud, theft, false accounting, offences against the administration of public justice, serious tax offences or other dishonesty; or relating to companies, building societies, insurance, banking or other financial services, insolvency, consumer credit or consumer protection, money laundering, market manipulation or insider dealing?

6.1.1b) Is the candidate currently the subject of any criminal proceedings, whether in the UK or elsewhere?

6.1.1c) Has the candidate ever been given a caution in relation to any criminal offence?

6.1.2) Has the candidate any convictions for any offences other than those in 6.1.1 above (excluding traffic offences that did not result in a ban from driving or did not involve driving without insurance)?

6.1.3) Is the candidate the subject of any ongoing criminal investigation?

6.1.4) Has the candidate been ordered to produce documents pursuant to any ongoing criminal investigation or been the subject of a search pursuant to any ongoing criminal investigation?

6.1.5 - Firms at which the candidate holds/held a position of influence

6.1.5a) Has any such firm been convicted of any criminal offence?

6.1.5b) Has any such firm been summonsed, charged with or otherwise investigated or prosecuted for any criminal offence?

6.1.5c) Has any such firm been the subject of any criminal proceeding which has not resulted in a conviction?

6.1.5d) Has any such firm been ordered to produce documents in relation to any criminal investigation or been the subject of a search?

6.2 - Civil Proceedings

6.2.1) Has the candidate ever been the subject of a judgement debt or award (whether satisfied or not)? Include all CCJs.

6.2.2) Has the candidate ever been party to any civil proceedings which resulted in any order against the candidate (other than a judgement debt/award in 6.2.1)?

6.2.3a) Is the candidate aware of any proceedings that have begun, or anyone's intention to begin proceedings, for a CCJ or other judgement debt?

6.2.3b) Is the candidate aware of more than one set of proceedings that may lead to a CCJ or other judgement debt?

6.2.4) Does the candidate have any current judgement debts (including CCJs) still outstanding?

6.2.5) Has the candidate ever failed to satisfy any judgement debt within one year of the order being made?

6.2.6a) Has the candidate ever filed for their own bankruptcy or had a bankruptcy petition served?

6.2.6b) Has the candidate ever been adjudged bankrupt?

6.2.6c) Has the candidate been the subject of a bankruptcy restrictions order or offered a bankruptcy restrictions undertaking?

6.2.6d) Has the candidate made any arrangements with creditors (e.g. deed of arrangement, IVA, or in Scotland a trust deed)?

6.2.6e) Has the candidate had assets sequestrated?

6.2.6f) Has the candidate been involved in any proceedings relating to the above bankruptcy matters?

6.2.7) Does the candidate or any undertaking under their management have any outstanding financial obligations arising from regulated activities?

6.2.8) Has the candidate ever been adjudged by a court/tribunal for fraud, misfeasance, negligence, wrongful trading or other misconduct? Or found to have lied on oath?

6.2.9a) Is the candidate currently party to any civil proceedings?

6.2.9b) Is the candidate aware of anybody's intention to begin civil proceedings against them?

6.2.10a) Has any firm at which the candidate holds/held a position of influence been adjudged civilly liable for fraud, misfeasance, wrongful trading or other misconduct?

6.2.10b) Has any such firm been the subject of a judgement debt or award?

6.2.10c) Has any such firm been party to civil proceedings resulting in an order against it?

6.2.11a) Is any firm at which the candidate currently holds/has held (within 12 months) a position of influence currently party to civil proceedings?

6.2.11b) Is any such firm aware of anyone's intention to begin civil proceedings?

6.2.12) Has any company/partnership of which the candidate is/has been a controller, director, senior manager etc. been put into liquidation, wound up, ceased trading, had a receiver/administrator appointed or entered into voluntary arrangement?

6.3 - Business and Employment Matters

6.3.1a) Has the candidate ever been disqualified from acting as a director or similar position?

6.3.1b) Has the candidate been the subject of any disciplinary proceedings (whether or not resulting in a finding)?

6.3.1c) Has the candidate been the subject of any investigation which has led or might lead to disciplinary proceedings?

6.3.1d) Has the candidate been notified of any potential disciplinary proceedings?

6.3.1e) Has the candidate been the subject of an investigation into allegations of misconduct or malpractice?

6.3.2) Has the candidate ever been refused entry to, dismissed, suspended or requested to resign from any professional, vocation, office or employment, or from any fiduciary office or position of trust?

6.3.3) Does the candidate have any material written complaints in the last five years which have been accepted, are awaiting determination, or have been upheld by an ombudsman or complaints scheme?

6.4 - Regulatory Matters

6.4.1 In relation to activities regulated by the FCA or any other regulatory body, has the candidate, or any company/partnership/unincorporated association of which the candidate is or has been a controller, director, senior manager, partner or company secretary (during and for 3 years after association) ever:

6.4.1a) Been refused, had revoked, restricted, suspended or terminated any licence, authorisation, registration, notification, membership or permission?

6.4.1b) Been criticised, censured, disciplined, suspended, expelled, fined or been the subject of other disciplinary or interventional action?

6.4.1c) Received a warning (public or private) that such action may be taken?

6.4.1d) Been the subject of an investigation by any regulatory body?

6.4.1e) Been required or requested to produce documents or information to any regulatory body?

6.4.1f) Been investigated or involved in an investigation by an inspector appointed under companies or other legislation?

6.4.1g) Ceased operating or resigned whilst under investigation, or been required to cease/resign by any regulatory body?

6.4.1h) Decided not to proceed with an application for any licence, authorisation, registration etc.?

6.4.1i) Been the subject of any civil action related to regulated activity which resulted in a court finding?

6.4.1j) Provided payment services or distributed/redeemed e-money where the agreement was terminated by the regulated firm?

6.4.1k) Been convicted, censured, disciplined or publicly criticised by any inquiry, the Takeover Panel or any governmental/statutory authority?

6.4.2 In relation to activities regulated by the FCA or any other regulatory body, has the candidate or any firm at which the candidate holds/has held a position of influence (during and within one year of association) ever:

6.4.2a) Been found to have carried on activities requiring authorisation/registration without the requisite authorisations?

6.4.2b) Been investigated for the possible carrying on of activities requiring authorisation without the requisite authorisation?

6.4.2c) Been found to have performed a senior management function without the requisite approval?

6.4.2d) Been investigated for the possible performance of a senior management function without the requisite approval?

6.4.2e) Been found to have failed to comply with obligations under the Electronic Money Regulations 2011 or Payment Services Regulations?

6.4.2f) Been the subject of a prohibition order under section 56 of FSMA 2000, or received a warning notice, or received a private warning?

6.5 - Other Matters

6.5.1) Is the candidate aware of any business interests, employment obligations, or other circumstance which may conflict with the performance of the senior management functions?

6.5.2) Is the candidate or firm aware of any other information relevant to this notification that the FCA might reasonably expect?

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15. ADDITIONAL INFORMATION

If you have answered 'yes' to any of the regulatory disclosures, please provide further information here, quoting the question number the explanation relates to. Also add any further information needed for the whole application, quoting the section number.

Additional Information / Disclosure Details

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