AgencyApplicationForm - Magenta Insurance

Legal status of the Firm

Sole trader

Partnership (other than a limited liability partnership or limited partnership)

Limited liability partnership (LLP)

Limited partnership

Public limited company (PLC)

Private limited company (LTD)

Unincorporated association

Other

Company Registration Number

For partnerships and companies only, please list all partners / directors

Director 1

Full Name

Position

Director 2

Full Name

Position

Director 3

Full Name

Position

Director 4

Full Name

Position

Does anyone else other than those detailed above have any ownership, shareholding, voting power or other significant influence in your business?

Select an option (required)

Yes

3. Principal Place of Business Details

Address of the principal place of business where the day-to-day business is transacted:

Telephone number of principal place of business

Fax number of principal place of business

Key Contact Name

Website Address

4. Registered Office Details

Address of Registered office (if different from head office above)

5. License Details

Are you licensed as a credit broker under the Consumer Credit Act 1974?

Select an option (required)

Yes

Please provide your CCL number

Are you registered with the Information Commissioner?

Select an option (required)

Yes

Please note the following categories required:

- Accounts & Records
- Insurance Administration
- Provision of Financial Services and Advice

Please provide your Information Commissioner Registration Number

6. General Insurance Activity

Which products do you wish this agreement to include?

Residential Property (Standard)

Residential Property (Non-standard)

Let Property (Standard)

Let Property (Non-standard)

High Networth Insurance

Travel Insurance

Do you sub-broke any business?

Select an option (required)

Yes

Are you a member of any professional insurance body?

Select an option (required)

Yes

If YES, please provide full details here separately

Total number of staff?

How do you usually source new Business?

Aggregators

Online

3rd Party Referrals

Recommendations

Cross-selling

Other

State your estimated annual gross insurance premium income for:

Residential Property (Standard)

Residential Property (Non-standard)

Let Property (Standard)

Let Property (Non-standard)

High Networth Insurance

Travel Insurance

What software system do you use for insurance administration?

What software system do you use for insurance quotations?

What software system do you use for insurance training?

Do you have policies and procedures in place to deal with issues of Bribery, Financial Crime, HMT Sanctions & Treating Customers Fairly?

- How often are these reviewed?

Do you have a Business Continuity Plan?

- How often is this reviewed and tested?

Consumer Duty:

Please confirm that your firm is able to meet the rules and obligations of Consumer Duty including:
- Acting in good faith towards retail customers
- Avoiding causing foreseeable harm to retail customers
- Supporting retail customers to pursue their financial objectives, ensuring they are equipped to make informed decisions and do not face unreasonable barriers.

Select an option (required)

Yes

Limit Indemnity

Date of expiry

10. Client Money

Do you have FCA permission to hold client money?

Select an option (required)

Yes

If no, do you require risk transfer?

Select an option (required)

Yes

DECLARATION

This declaration must be completed by the member applicant, as appropriate:

In the case of a sole trader – By the Sole Trader.
In the case of a company – By a Director.
In the case of a partnership – By a Partner.

I confirm that the information in this application 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 give inet3 Ltd permission to contact the other Principals for whom I am an Appointed Representative.

I confirm that inet3 Ltd have permission to carry out credit checks - either on the individual if the applicant is a sole trader, on each partner in the case of a partnership or on the company in the case of a limited company. The credit check will be carried out in order to assess your application and on a repeat basis, usually annually.

Agency Application Form

1. Agent’s Details

2. Legal Status of the Agent

Director 1

Director 2

Director 3

Director 4

3. Principal Place of Business Details

4. Registered Office Details

5. License Details

6. General Insurance Activity

7. Financial Position

8. Fitness & Propriety for Disclosure

9. Professional Indemnity Insurance

10. Client Money

DECLARATION

Certify