introducer-application - Cross-Border Worldwide

Introducer Application

Apply to become an Introducer for Cross-Border by filling out the form below.

Blank Form (#3)

Basic Details

*(including subsidiaries or trading names, if applicable)

Address Line 1

Address Line 2

City

State

Zip Code

Country

First Name

Last Name

Role

Company Website URL

Your Email

Trading Status of the Business

Sole trader

PLC

Limited Company

Partnership

Part of a Group

Other

Company Registration Number (if applicable)

Is the company authorised and/or regulated by the FCA?

Yes

Please give the Firm Reference Number (FRN)

Are you an Appointed Representative of another Principal?

Yes

Please give the Firm Reference Number (FRN)

Are you regulated by an alternative Professional Body / Regulator?

Yes

Please give the Firm Reference Number (FRN)

Have you ever had an appointment as an Introducer or Appointed Representative terminated?

Yes

Please state which:

Are you a Member of a Network?

Yes

Please state which:

Are you a Member of any Professional Trade Organisations/Bodies?

Yes

Please state which:

Have you ever been investigated, publicly censored, disciplined, suspended or expelled by the FCA, another regulator, a professional body?

Yes

Please give details:

Are you currently the subject of any disciplinary proceedings by the FCA, another regulator, a professional body, a trade body or a government body or agency?

Yes

Please give details:

Are you currently or have you been the subject of any investigation by the FCA, another regulator, a professional body, a trade body or a government body or agency which has led to a requirement or undertaking significant remedial action, a past business review, customer remediation programme or the engagement of skilled persons?

Yes

Please give details:

Have you had any application for membership of any Professional Trade Organisations/Bodies refused, cancelled, declined or withdrawn?

Yes

Please state which one and the reason:

Are you exempt from authorisation and regulation by the Financial Conduct Authority?

Yes

Are you a member of a Designated Professional Body (DPB)?

Yes

Please state DPB and Reference Number:

Do you have external compliance support (e.g. from a consultant, service provider or similar)?

Yes

Please give details:

Do you have Network permission to introduce cases outside of the Network?

Yes

Does your firm or network have the permissions and service to undertake Pension Transfer advice?

Yes

As you or your network can provide Transfer advice, please give reasons why you are looking to outsource DB transfers.

When was the business established?

Number of Staff:

Number of Advisers:

Number of Active Clients:

Approximate value of Assets under Administration (£):

Please briefly describe your business model, including the services you provide and how these are distributed:

Please describe how you generate new clients (e.g. use of lead generators, word of mouth recommendations, etc.) and confirm how these apply to the clients you intend to introduce to Pensionhelp.

Does your firm have a Centralised Investment Proposition (CIP)?

Yes

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.

Structured Products (Geared Downside)

1-5%

6-10%

11-25%

25%+

Hedge Funds

1-5%

6-10%

11-25%

25%+

Any Investments for Tax Structuring

1-5%

6-10%

11-25%

25%+

Unregulated Collective Investment Schemes/ Non Mainstream Pooled Investments

1-5%

6-10%

11-25%

25%+

Traded Life Policies

1-5%

6-10%

11-25%

25%+

Viatical Settlements / Life Settlement Products

1-5%

6-10%

11-25%

25%+

Traded Endowment Policies

1-5%

6-10%

11-25%

25%+

Exchange Traded Products

1-5%

6-10%

11-25%

25%+

Other Geared or Leveraged Investments

1-5%

6-10%

11-25%

25%+

Own Branded Collective Investment Schemes / DIFs

1-5%

6-10%

11-25%

25%+

Commodities or Commodity Funds

1-5%

6-10%

11-25%

25%+

Commercial Property

1-5%

6-10%

11-25%

25%+

Foreign Emerging Markets

1-5%

6-10%

11-25%

25%+

VCTs

1-5%

6-10%

11-25%

25%+

IPOs

1-5%

6-10%

11-25%

25%+

REITs

1-5%

6-10%

11-25%

25%+

Buy to Let

1-5%

6-10%

11-25%

25%+

Equity Release

1-5%

6-10%

11-25%

25%+

Sub Prime Mortgages

1-5%

6-10%

11-25%

25%+

Does your firm have a preferred Platform Provider or Providers?

Yes

Please indicate which one(s) and indicate the reason(s):

Does your firm have any preferred product providers?

Yes

Please indicate which one(s) and indicate the reason(s):

Do you have your own Professional Indemnity Insurance in place?

Yes

If you have provided advice on any of the investments on previous page, are any of these investments specifically excluded from your Professional Indemnity Insurance?

Yes

Please provide details of any exclusions

Any One Claim

In the Aggregate

Has any Claim ever been made under your PI or D&O policy(ies) in the past two years?

Yes

Has any Claim ever been made under your PI or D&O policy(ies) in the past two years? Please provide brief details:

Has it been necessary for you to advise your PI Insurers of any circumstances which you believed might give rise to a Claim under the policy, even if this subsequently did not happen?

Yes

Please provide brief details:

Complaints

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

The total number of complaints received:

The number of complaints upheld by your firm:

The number of complaints referred to the Financial Ombudsman Service (FOS):

The number of complaints upheld by FOS:

The number of complaints (whether upheld or not) which relate to any aspect of the ongoing servicing of assets held within a pension scheme:

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

Title

First Name

Last Name

IRN

Role / Title

Business Referrer

Yes

Person Two

Title

First Name

Last Name

IRN

Role / Title

Business Referrer

Yes

Person Three

First Name

Last Name

IRN

Role / Title

Business Referrer

Yes

If you would like to add more people please provide their details below.

Has any Director, Partner, Executive or Senior employee been convicted of any dishonest or fraudulent act, or implicated in such an act by a legally constituted court by Court of Justice?

Yes

Please provide details:

Has any Director, Partner, Executive or Senior employee subject to any current criminal proceeding?

Yes

Please provide details:

Has any Director, Partner, Executive or Senior employee ever been given a caution in relation to any criminal offence?

Yes

Please provide details:

Has any Director, Partner, Executive or Senior employee ever had a County Court Judgement (“CCJ”) or other judgement debt, whether satisfied or not and whether discharged or not, or aware of any proceeding that have begun, or anybody’s intention to begin proceedings?

Yes

Please provide details:

Has any Director, Partner, Executive or Senior employee ever been, the subject of an action or any bankruptcy proceedings, or proceedings for the sequestration of your/Company estate?

Yes

Please provide details:

Has any Director, Partner, Executive or Senior employee ever been put into liquidation, wound up, ceased trading, had a receiver or administrator appointed or entered into any voluntary arrangement with creditors?

Yes

Please provide details:

Has any Director, Partner, Executive or Senior employee ever been adjudged by a court liable for any fraud, misfeasance, wrongful trading or other misconduct?

Yes

Please provide details:

Key Contacts (If Applicable)

Please indicate any other key contacts for Pensionhelp:

Key Contact One

Role / Title

First Name

Last Name

Title

Telephone Number

Key Contact Two

Role / Title

First Name

Last Name

Title

Telephone Number

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.

Do you wish to receive payments for introductions made to Pensionhelp?

Yes

Account Details

NMBA Member

Are you an NMBA Member?

Yes

Additional Information

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.).

me description about this section

I agree to the declaration statement?

Yes

First Name

Last Name

I have read and agree to the Terms and Conditions and Privacy Policy

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