I-Link Broker

Home Insurance and MPPI Introducer

If you have an existing agency with Select & Protect, advice your agency reference

Name of applicant:

Title

First name:

Surname:

Company name:

Address:

Trading name:(if different)

Contact name (if different):

Title:

First name:

Surname:

Contact details:

Telephone Office:

Mobile:

Fax:

E-mail:

Website address

Registered address

Legal status

Regulatory status

Sole trader

Limited Liability

Partnership

Private limited company

Public limited company

Other

1. Authorised by the FSA for arranging (bringing about) deals in investments for:
Non-investment insurance business
Other areas of business

FSA Firm reference number

Please download, read and confirm your acceptance of the FSA Agreement between you and Select & Protect.

I have read and accept the Agreement and confirm I have the necessary authority to enter into this Agreement.

2. AR and/or IAR of others:
Your FSA form reference number
Does your principal(s) prohibit you from introducing business to us? YES NO

3. Neither FSA Authorised or an AR/IAR

Identification

For a private individual, we will require copies of identification documentation - one from column A and two from column B below, as well as your National Insurance number which is mandatory. For companies, we will require a copy of one identification document from column A

If originals are sent they will be returned to you by Special Delivery post. Photocopies are acceptable and will be security shredded by us unless you specifically request they are returned to you.

Sole Trader

Passport

Current UK or EEA Driving Licence

Birth Certificate

(as well as your National Insurance number which is mandatory)

Company

Companies House registration

VAT registration document

PII Insurance documentation

Public utility bill or book i.e. gas, electric, water, phone (land line), issued or dated within the last three months

Local Authority bill (council tax bill) valid for the current year

Bank, Building Society or credit card statement issued within the last three months

Mortgage statement or tenancy agreement

NHS Medical Card