Introducer Application

introducer-application Cross-Border Worldwide
Blank Form (#3)
Basic Details

Please indicate which of the following (if any) you have advised on or provided services in the last 2 years and the approximate percentage of your total revenue generated by each:

Evaluate the following statements.

Complaints

Please confirm the number of complaints received by your firm in the last 2 years.

About Your People

Please provide details of all Relevant Directors, Partners, Executives, Senior Employees (including Advisers and the Person Responsible for Compliance). Where relevant, please provide the person's FCA Individual Reference Number (IRN): Please indicate if the individual will refer business to Pensionhelp so we can set up a Login for our introducer website.

 

Person One
Person Two
Person Three

Key Contacts (If Applicable)

Please indicate any other key contacts for Pensionhelp:

Key Contact One

Key Contact Two

Introducer Payments

If you wish to receive an Introducer Payment via BACS, please provide us with the appropriate bank details below. Please also provide a bank statement / crossed cheque for this account. We require this to confirm the details of the account and that it belongs to your firm. We will return the document to you.

NMBA Member

So

Declaration

Please Note: It should not be assumed that information is known to Pensionhelp Ltd by virtue of the fact it is in the public domain or has previously been disclosed to us. If there is any doubt about the relevance of information, it should be included.

For the purpose of complying with the General Data Protection Register, any personal information provided in this Form will be used by Pensionhelp Ltd only as a means of due diligence as part of the application process to become an introducer. Unless we are obligated to make a disclosure to a regulator or similar authority, the information within this form will not be disclosed for any purpose without the permission of the applicant.

Pensionhelp Ltd may seek to verify the information given in this form including answers relating to the fitness and propriety of the business or its people.

Statement

In signing the form below: I warrant that I have the authority to provide the information above and to enter into the application to be an Introducer of Clients to Pensionhelp Ltd, and that I have read and agree with the Pensionhelp Privacy Notice.

I authorise Pensionhelp Ltd to make such enquries and seek information as it believes necessary in the course of verifying the information provided in this form.

I confirm that the information provided in this form is accurate and complete to the best of my knowledge and belief.

I undertake to advise Pensionhelp Ltd in writing of any changes in circumstances in respect of the information provided in this form including but not limited to:

  • Any changes of address
  • Any changes of Directors, Partners, Executives or Senior Employees
  • A change in your regulated status
  • A change of principal or network
  • Your Company's insolvency, liquidiation, entering into an arrangement with creditors or a receiver being appointed
  • The bankruptcy of a Director, Partner, Executive or Senior Employee
  • If any Director, Partner, Executive or Senior Employee becomes subject to disciplinary or investigatory proceedings at the order of a professional body, trade association or regulatory body
  • Changes to your Professional Indemnity Insurance (such as a failure to obtain/renew such insurance, significant exclusions, etc.).
  • Changes to your Directors and Officers Insurance (such as a failure to obtain/renew such insurance, significant exclusions, etc.).

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