Scotland check. 1.8 National Insurance number. 1.9 If you have a temporary National Insurance number or no National Insu
FOR INTERNAL USE ONLY June 2016
Individual Application
Completing the Application The information you supply in this application will form the basis of your contract with Intrinsic Financial Planning Limited, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) Limited. Much of the information we ask for is prescribed by the Financial Conduct Authority (FCA). We will acknowledge receipt of your application by email. Once we begin processing your application we will send you, by email, an action list. This will show what we are working on and will detail any additional information you need to send us. The FCA requires us to be satisfied of an individual’s suitability to perform a Controlled Function or become an Approved Person. We need to do this before we can issue a contract, irrespective of whether you are already performing one of these roles. The FCA considers the following of utmost importance: • Honesty, integrity and reputation • Competence and capability • Financial soundness Therefore, it is vitally important that the information you provide is ‘full and frank’; we will need to verify this information to satisfy the FCA requirements. We want you to start trading as soon as possible. Therefore, it is absolutely essential that you provide accurate information. If we subsequently discover you have made a material non-disclosure we will terminate your contract. This may appear on any future references we are asked to provide, which may make it difficult for you to work with any other Authorised Firm. If there is anything that may be detrimental to your application, you must tell us and explain fully in the Additional Information page at the back of the application. If in doubt, tell us! If you have any questions, please contact the Intrinsic Recruitment Team on 01793 647400.
1
Section 1 – Applicant Details 1.1 Full name
Title Surname
Forenames
1.2 Previous names - if you are known, or have previously been known, by any other names or have a former name(s) or surname(s), please enter full details
1.3 Contact details
Other names Former name(s) Date of name change Reason for name change
Home Telephone Office Telephone Mobile Email address
POST APPOINTMENT CONTACT DETAILS Office Telephone Email Address This is the address we will use for all future communication
Fax 1.4 Current Address
Address
Town County Postcode
Month Dates at this address
From To
2
Year
1.5 Previous address(es) If you have not resided at your current address for more than five years, please enter previous addresses. Address 1
Address 2
Town
Town County
County
Postcode
Postcode
Dates at this address
Month
Year
Month
From
From
To
To
Day
Year
Month
Year
1.6 Date of birth 1.7 Please confirm that you give consent for a Disclosure Scotland check
Yes
No
1.8 National Insurance number 1.9 If you have a temporary National Insurance number or no National Insurance number, have you applied for a permanent number?
Yes
No
N/A
1.10 Nationality at Birth 1.11 Have you changed your nationality since birth, if so please provide your current nationality 1.12 Town of birth 1.13 Country of birth 1.14 If born outside the EU, how long have you lived in the UK? 1.15 Mothers maiden name NB: If you are not British, nor an EU citizen, please provide proof of indefinite right to remain and work in the UK. Acceptable proof is your original passport or original correspondence from the Home Office. 1.16 Are you applying as:
Non-Selling Principal
Selling Principal – General Insurance Adviser Selling Principal – Financial Planning Adviser
Registered Individual – Financial Planning Adviser
Registered Individual – Mortgage Adviser
Selling Principal – Mortgage Adviser
Registered Individual – General Insurance Adviser
3
1.17 Are you applying to join: An existing Firm
A new Applicant Firm
Intrinsic Financial Planning Limited
Intrinsic Wealth Limited
Positive Solutions (Financial Services) Limited
Intrinsic Mortgage Planning Limited Name of Firm ill you be conducting pension W transfer business as part of your proposition
ill you be conducting Mortgage W Planning business as part of your proposition
Yes No
Yes No
Section 2 – Professional Qualifications 2.1 Professional qualifications Please select the relevant boxes to indicate the qualifications that you have attained. Copies of the appropriate examination certificates must be sent to the Intrinsic Recruitment Team together with a copy of your Learning Statement or Academic Summary. If you are already a financial planner, please also submit your Statement of Professional Standing.
CII
CII
IFS
FPC1
Yes
No
CeMAP 1
Yes
No
JO1
Yes
No
JO9
Yes
No
FPC2
Yes
No
CeMAP 2
Yes
No
JO2
Yes
No
J1O
Yes
No
FPC3
Yes
No
CeMAP 3
Yes
No
JO3
Yes
No
J11
Yes
No
CF 1
Yes
No
CeMAP Bridge
Yes
No
JO4
Yes
No
J12
Yes
No
CF 2
Yes
No
CeFA 1
Yes
No
JO5
Yes
No
RO1
Yes
No
CF 3
Yes
No
CeFA 2
Yes
No
JO6
Yes
No
RO2
Yes
No
CF 4
Yes
No
CeFA 3
Yes
No
JO7
Yes
No
RO3
Yes
No
CF 5
Yes
No
CeFA 4
Yes
No
JO8
Yes
No
RO4
Yes
No
CF 6
Yes
No
IFS DIPLOMA
Yes
No
Yes
No
RO5
Yes
No
MAQ
Yes
No
CII DIPLOMA
RO6
Yes
No
RO7
Yes
No
RO8
Yes
No
Do you have any Equity Release qualifications?
Yes
No
(If yes, please forward a copy of your relevant qualification certificate) If no financial services qualifications have been obtained please provide full details of any higher level qualifications obtained.
4
Section 3 – Activity Activity history - last five years Please provide details of your complete employment/self employment (full and/or part-time) unemployment and/or education for the last five years from the date of completing your application. References will be requested from past and present employers. For periods of unemployment or where benefits have been claimed, verification will be requested from the DWP Office, or your personal referees. If there are any employers you would prefer us not to contact at this stage, please let us know and give a full explanation below. Please note that in order to process your application we must request references from all previous employers in the last three years, and these references will need to be received prior to your appointment. 3.1 Work History Name
Fax Number
Nature of Business
Email Address
Address of Firm Dates of employment/Self employment/Education From
Town
Month Year
County Postcode
To
Month Year
Telephone number Current income
£
Is the firm regulated by the FCA? Are you or the firm an appointed representative?
Yes
No
Yes
No
If yes, please confirm the life assurance company or network Date your authorisation commenced What is your current role, or job title and responsibilities? Current employment status
Employed
Resignation
Unemployed
Retirement
Self Employed
Termination / dismissal
Education
End of contract Redundancy
Notice Period (weeks) Please advise when you intend to resign Can we contact this firm for a reference? (please note, a reference request will be issued immediately if you tick ‘Yes’)
Yes
No
Yes
No
If ‘No’, please tell us why Do you have the status of Competent Adviser?
5
3.2 Work History Name
Fax Number
Nature of Business
Email Address
Address of Firm Dates of employment/Self employment/Education From
Town
Month Year
County Postcode
To
Month Year
Telephone number
Income
£
Was this firm regulated by the FCA?
Were you or the firm an appointed representative?
Yes
No
Yes
No
If yes, please confirm the life assurance company or network What was your role, or job title and responsibilities? Employment status
Reason for leaving
Employed Unemployed
Resignation Retirement
Self Employed
Termination / dismissal
Education
End of contract Redundancy
Can we contact this firm for a reference? (please note, a reference request will be issued immeditately if you tick ‘Yes’)
Yes
If ‘No’, please tell us why
6
No
3.3 Work History Name
Fax Number
Nature of Business
Email Address
Address of Firm Dates of employment/Self employment/Education From
Town
Month Year
County Postcode
To
Month Year
Telephone number Income
£
Was this firm regulated by the FCA?
Were you or the firm an appointed representative?
Yes
No
Yes
No
If yes, please confirm the life assurance company or network What was your role, or job title and responsibilities? Employment status
Reason for leaving
Employed Unemployed
Resignation Retirement
Self Employed
Termination / dismissal
Education
End of contract Redundancy
Can we contact this firm for a reference? (please note, a reference request will be issued immeditately if you tick ‘Yes’)
Yes
If ‘No’, please tell us why
7
No
3.4 Work History Name
Fax Number
Nature of Business
Email Address
Address of Firm Dates of employment/Self employment Month
From
Town
Year
County Postcode
To
Month Year
Telephone number Income
£
Was this firm regulated by the FCA?
Were you or the firm an appointed representative?
Yes
No
Yes
No
If yes, please confirm the life assurance company or network What was your role, or job title and responsibilities? Employment status
Reason for leaving
Employed Unemployed
Resignation Retirement
Self Employed
Termination / dismissal
Education
End of contract Redundancy
Can we contact this firm for a reference? (please note, a reference request will be issued immeditately if you tick ‘Yes’)
Yes
If ‘No’, please tell us why
3.5 Please provide dates and names of all the Life Assurance Companies or Networks of which you have been an appointed representative in the last 5 years Date
Company
Date
Company
Date
Company
Date
Company
8
No
Section 4 – Company Directorship Details 4.1 Have you ever held any company Directorships or Partnerships whether current or not? (Please include ALL Directorships or Partnerships ever held)
Yes
No
Yes
No
If yes, please give details
Will the above Directorships or Partnerships continue? If no, what has happened/is happening to them?
If yes, please provide details of your future intentions and the nature of your responsibilities.
Do you have any financial liabilities outstanding regarding this Directorship/Partnership or have you ever signed a Deed of Guarantee?
Yes
No
(Please provide further details under Additional Information at the back of the application)
Section 5 – Accountant Details 5.1 Accountant details Title
Address
Surname Initials
Town County Postcode Telephone Number Fax Number Email Address How long has the above been your Accountant?
Month From To
9
Year
Trade Referees If you have been self employed within the last 3 years in an industry which is not within the financial services sector, please provide the names and addresses of 2 Trade Referees who can verify your trading activities.
Trade Name: Company Name:
Trade Name: Company Name:
Trade address:
Trade address:
Trade email address:
Trade email address:
Referee phone number:
Referee phone number:
Dates of your trading activites to be covered
Dates of your trading activites to be covered
Personal Referees If you have any gaps in employment within the last 3 years where you have not been working, please provide the names and addresses of 2 Personal Referees who can verify your activities during these gaps. Referee Name:
Referee Name:
Referee address:
Referee address:
Referee phone number:
Referee phone number:
Dates of unemployment:
Dates of unemployment:
Referee email address:
Referee email address:
Your relationship to referee:
Your relationship to referee:
Please note these Personal Referees cannot be family members or individuals with a relationship to Intrinsic.
10
Section 6 – Business Conduct Non-disclosure of relevant information may result in your application being declined. If you answer Yes to any of these questions, please provide full details in the Additional Information page at the back of the application. 6.1 General a. Have you ever been dismissed or asked to leave by any employer or network of life Assurance company?
Yes
No
b. Have you ever received any warnings, written or verbal?
Yes
No
c. Have you ever had an investigation or review carried out on you or the business conducted by you?
Yes
No
Yes
No
e. Have you ever been assessed by the FCA or any authorised firm or regulatory body?
Yes
No
f. If you have been assessed please provide a copy of your assessment report? and RMAR (if applicable)?
Yes
No
g. Have you ever been removed from a Lenders panel or had an agency refused or terminated by a Product Provider?
Yes
No
h. Have you ever acted in a Directly Authorised capacity? No
Yes
No
i. If yes, please provide a copy of your latest RMAR. Is this enclosed?
Yes
No
j. Have you ever had any remedial action in relation to treating customers fairly?
Yes
No
ave you ever been involved in the promotion, advice or selling of Arch Cru, k. H Key Data or high risk products?
Yes
No
l. Have you ever had any complaints against you whether upheld or not? If yes please complete section 6.2 below.
Yes
No
m. Have you ever been the subject of a breach in relation to activities regulated by the Financial Conduct Authority.
Yes
No
n. H ave you ever applied to Intrinsic prior to this application?
Yes
No
d. Have you ever undertaken or been asked to undertake any additional training, including increased supervision, under any Training and Competence Scheme?
6.2
Complaints Please provide full details regarding any complaints against you whether upheld or not. Customer
Date
Nature of the complaint
11
Outcome/Settlement
Redress compensation amount
6.3 Other a. Do you have any trading names?
Yes
No
b. Are you a shareholder in any other financial services company where your shareholding exceeds 10% of total shares issued?
Yes
No
c. Have you ever held, or do you currently hold, any contracts with any
Yes
No
Yes
No
If yes, please give full name(s)
financial services company which are not listed in the employment section of of the application? d. D o you or have you ever had any business relationship or association with any Independent Financial Adviser, Financial Services Company or Director/ Representative of such a company, excluding those listed in the employment section of the application? If yes, please provide details below.
Name of Company/Individual
Details of Business Relationship
e. Do you have any outstanding debts with any Financial Services Company? If yes, please enter full details below
Company
Amount of Debt
Yes
No
Details of Arrangements to Repay the Debt
6.4 Data Protection Licence (DPL) Do you have a current DPL?
Yes
No
If yes, please provide a copy or reference number If no, please be aware that you must obtain your Data Protection Licence from the Information Commissions Office (ICO) prior to representing Intrinsic Financial Planning Limited, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) Limited.
12
Section 7 – Fitness and Propriety If you answer Yes to any of the quetions in this section please provide all details in the Additional Information page at the back of the application. 7.01 Criminal Proceedings When answering the questions in this section you should include matters whether in the UK or overseas. By virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975, you are the subject to the law of England and Wales, you must disclose spent convictions and cautions (other than a protected conviction or caution). In the following questions, you should include all matters even when the arrest, charge, prosecution or investigation did not result in a conviction, and, in respect of 7.01.4, even where you were not the subject of the investigation. 7.01.1 a Have you ever been convicted of any criminal offence (whether spent or not and whether or not in the United Kingdom): i. involving fraud, theft, false accounting, offences against the administration of public justice (such as perjury, perverting the course of justice and intimidation of witnesses or jurors), serious tax offences or other dishonesty or ii.
relating to companies, building societies, industrial and provident societies, credit unions, friendly societies, insurance, banking or other financial services, insolvency, consumer credit or consumer protection, money laundering, market manipulations or insider dealing?
Yes
No
Yes
No
Yes
No
b
Are you or have you ever been, the subject of any criminal proceedings, whether in the UK or elsewhere?
Yes
No
c
Have you ever been given a caution in relation to any criminal offence?
Yes
No
Yes
No
7.01.2 Have you any convictions for any offences other than those in 7.01.1 above (excluding traffic offences that did not result in a ban from driving or did not involve driving without insurance)? 7.01.3
Have you ever been arrested or charged with any criminal offence or been the subject of any criminal investigation? (You should include all matters even if the arrest, charge or investigation did not result in a conviction.)
Yes
No
Yes
No
a Been convicted of any criminal offence?
Yes
No
b Been summonsed, charged with or otherwise investigated or prosecuted for any criminal offence?
Yes
No
c Been the subject of any criminal proceeding which has not resulted in a conviction?
Yes
No
d Been ordered to produce documents in relation to any criminal investigation or been the subject of a search (with or without a warrant) in relation to any criminal investigation?
Yes
No
7.01.4 Have you ever been ordered to produce documents pursuant to any criminal investigation or been the subject of a search (with or without a warrant) pursuant to any criminal investigation? 7.01.5 Has any firm at which you held a position of influence ever:
13
7.02 Civil Proceedings 7.02.1 Have you ever been the subject of a judgement debt or award against you?
Yes
No
Yes
No
Please give a full explanation of the events in question. You should include all Count Court Judgement(s) (CCJs) made against the candidate (whether satisfied or not); and i) the sum and date of all judgement debts, awards or CCJs (whether satisfied or not); and ii) the total number of all judgment debts, awards or CCJs ordered.
7.02.2 Have you ever been party to any civil proceedings which resulted in any order against you (other than a judgement debt or award referred to in 7.02.1 above)? (You should include, for example, injunctions and employment tribunal proceedings.) 7.02.3 Are you aware of:
a A ny proceedings that have begun, or anyone’s intention to begin proceedings against you, for a CCJ or another judgement debt?
Yes
No
ore than one set of proceedings, or anyone’s intention to begin b M more than one set of proceedings, that may lead to a CCJ or other judgement debt?
Yes
No
Yes
No
Yes
No
Yes
No
c Anybody’s intention to claim more than £1,000 of CCJs or judgement debts in total from you?
7.02.4 D o you have any current judgment debts (including CCJs) made under a court order still outstanding, whether in full or in part? 7.02.5 H ave you ever failed to satisfy any such judgment debts (including CCJs) made under a court order still outstanding, whether in full or part, within one year of the order being made?
14
7.02.6 Have you ever: Yes
No
Yes
No
c Been the subject of a bankruptcy restrictions order (including an interim bankruptcy restrictions order) or offered a bankruptcy restrictions undertaking?
Yes
No
d Made any arrangements with your creditors, for example a deed of arrangement or an individual voluntary arrangement (or in Scotland a trust deed)?
Yes
No
e Had assets sequestrated?
Yes
No
f Been involved in any proceedings relating to the above matters even if such proceedings did not result in the making of any kind of order against you or result in any kind of agreement with you?
Yes
No
7.02.7 Do you, or any undertaking under their management, have any outstanding financial obligations arising from regulated activities, which have been carried out in the past? (whether or not in the UK or overseas)?
Yes
No
7.02.8 Have you ever been adjudged by a court or tribunal (whether criminal, civil or administrative) for any fraud, misfeasance, negligence, wrongful trading or other misconduct?
Yes
No
a Party to any civil proceedings? (including those covered in 7.02.2 above)
Yes
No
b Aware of anybody’s intention to begin civil proceedings against you? (you should include any ongoing disputes whether or not such dispute is likely to result in any order against you.)
Yes
No
a Adjudged by a court civilly liable for any fraud, misfeasance, wrongful trading or other misconduct?
Yes
No
b The subject of a judgement debt or award against the firm? (you should include all CCJs) made against the firm, whether satisfied or not.
Yes
No
Yes
No
a Filed for your own bankruptcy or had a bankruptcy petition served on you?
b Been adjudged bankrupt?
7.02.9 Are you currently:
7.02.10 Has any firm at which you hold or have held a position of influence ever been:
c Party to any other civil proceedings which resulted in an order against the firm other than in relation to matters covered in 7.02.10a and 7.02.10b above?
15
7.02.11 Is any firm at which you currently hold or have held, within the last 12 months from the date of the submission of this form, a position of influence currently: Yes
No
Yes
No
Yes
No
Yes
No
b The subject of any proceedings of a disciplinary nature (whether or not the proceedings resulted in any finding against you)?
Yes
No
c The subject of any investigation which has led or might lead to disciplinary proceedings?
Yes
No
d N otified of any potential proceedings of a disciplinary nature against you?
Yes
No
e T he subject of an investigation into allegations of misconduct or malpractice in connection with any business activity? (this question covers internal investigation by an authorised firm, as well as investigation by a regulatory body, at any time.)
Yes
No
Yes
No
Yes
No
Yes
No
a a party to civil proceedings?
b aware of anyone’s intention to begin civil proceedings against them?
7.02.12 Has any company, partnership or unincorporated association of which you are or have been a controller, director, senior manager, partner or company secretary, in the United Kingdom or elsewhere, at any time during their involvement, or within one year of such an involvement, been put into liquidation, wound up, ceased trading, had a receiver or administrator appointed or entered into any voluntary arrangement with its creditors? 7.03 Business and Employment Matters 7.03.1 Have you ever been: a Disqualified from acting as a director or similar position (one where you act in a management capacity or conducts the affairs of any company, partnership or unincorporated association)?
7.03.2 Have you ever been refused entry to, or been dismissed, suspended or requested to resign from, any professional, vocation, office or employment, or from any fiduciary office or position of trust whether or not remunerated? 7.03.3 Do you have any material written complaints made against you by your clients or former clients in the last five years which you have accepted, or which are awaiting determination, or have been upheld – by an ombudsman or complaints scheme? 7.03.4 Have you ever participated in an arbitration board?
16
7.04 Regulatory Matters 7.04.1 In relation to activities regulated by the FCA and/or PRA or any other regulatory body have: • You, or • Any company, partnership or unincorporated associate of which you are or have been a controller, director, senior manager, partner or company secretary, during the candidate’s association with the entity and for a period of three years after you ceased to be associated with it, ever – a Been refused, had revoked, restricted, been suspended from or terminated, any licence, authorisations, registration, notification, membership or any other permission granted by any such body?
Yes
No
b B een criticised, censured, disciplined, suspended, expelled, fined or been the subject of any other disciplinary or interventional action by any such body? c Received a warning (whether public or private) that such disciplinary or interventional action may be taken against you or the firm?
Yes
No
Yes
No
een the subject of an investigation by any regulatory body, whether or not d B such an investigation resulted in a finding against you or the firm?
Yes
No
e B een required or requested to produce documents or any other information to any regulatory body in connection with such an investigation (whether against the firm or otherwise)?
Yes
No
Yes
No
g C eased operating or resigned whilst under investigation by any such body or been required to cease operating or resign by any regulatory body?
Yes
No
h D ecided, after making an application for any licence, authorisation, registration, notification, membership or any permission granted by any such body, not to proceed with it?
Yes
No
i Been the subject of any civil action related to any regulated activity which has resulted in a finding by a court?
Yes
No
j Provided payment services or distributed or redeemed e-money on behalf of a regulated firm or itself under any contractual agreement where that agreement was terminated by the regulated firm?
Yes
No
k Been convicted of any criminal offence, censured, disciplined or publicly criticised by any inquiry, by the Takeover Panel or any governmental or statutory authority or any other regulatory body (other than as indicated in this group of questions).
Yes
No
l Been on a board of directors in an operating undertaking that has not been granted a release from liability?
Yes
No
een investigated or been involved in an investigation by an inspector f B appointed under companies or any other legislation, or required to produce documents to the Secretary of State, or any other authority, under any such legislation?
17
7.04.2 In relation to activities regulated by the FCA/PRA or any other regulatory body, have you or any firm at which you hold or have held a position of influence at any time during and, within one year of your association with the firm, ever:
een found to have carried on activities for which authorisation or a B registration by the FCA/PRA or any other regulatory body is required without the requisite authorisations?
b B een investigated for the possible carrying on of activities requiring authorisation or registration by the FCA/PRA or any other regulatory body without the requisite authorisation whether or not such investigation resulted in a finding against you?
Yes
No
Yes
No
c Been found to have performed a controlled function (or an equivalent function requiring approval by the FCA/PRA or any other regulatory body) without the requisite approval?
Yes
No
een investigated for the possible performance of a controlled d B function (or an equivalent function requiring approval by the FCA/PRA or any other regulatory body) without the requisite approval, whether or not such investigation resulted in a finding against you?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
e Been found to have failed to comply with an obligation under the Electronic Money Regulations 2011 or Payment Services Regulations 2009 to notify the FCA/PRA of the identity of a person acting in a position of influence over its electronic money or payment services business? een the subject of disqualification direction under section 59 of the f B Financial Services Act 1986 or a prohibition order under section 56 FSMA, or received a warning notice proposing that such a direction or order be made, or received a private warning?
7.05 Other Matters 7.05.1 A re you, in the role to which the application relates, aware of any business interests, employment obligations, or any other circumstance which may conflict with the performance of the controlled functions for which approval is now being sought in the respect of your control of the firm with your role as controller of the applicant firm or your role as controller? 7.05.2 For large NDF firms only. Candidates for CF30 only, are not required to answer this question. Do you have, or know of, any: a) Qualifying ownership or any other form of substantial influence in the firm or group, or any other companies?
If Yes, please provide:
1. Company name and registration number
2. Nature and scope of the operations 3. The registered office of the company 4. Possession in percentage
b) Close relatives with ownership shares in the firm or group?
c) Close relatives with any other financial relations in the firm or group?
d) Any other comments that may give rise to a conflict of interest
Yes
No
7.05.3 Are you aware of any other information relevant to this application that we might reasonably expect from you?
Yes
No
If you have answered Yes to any of the questions in section 7 please provide full details in the Additional Information page at the back of the application form. 18
Declarations and Signatures Application to perform controlled functions under the approved persons regime to the Financial Conduct Authority
Declaration of Candidate Knowingly or recklessly giving the FCA and/or PRA information which is false or misleading in a material particular may be a criminal offence (section 398 of the Financial Services and Markets Act 2000). It should not be assumed that information is known to the FCA and/or PRA merely because it is in the public domain or has previously been disclosed to the FCA and/or PRA or another regulatory body. If there is any doubt about the relevance of information, it should be included. For the purposes of complying with the Data Protection Act, the personal information provided in this Form will be used by the FCA and PRA to discharge its statutory functions under the Financial Services and Markets Act 2000 and other relevant legislation, and will not be disclosed for any other purpose without the permission of the applicant. With reference to the above, the FCA and/or PRA may seek to verify the information given in this Form including answers pertaining to fitness and propriety. This may include a credit reference check. In signing the form below: a) I authorise the FCA and/or PRA to make such enquiries and seek such further information as it thinks appropriate in the course of verifying the information given in this Form. Individual candidates may be required to apply to the Disclosure and Barring Service for a search to be made as to whether any criminal records are held in relation to them and to disclose the result of that search to us. I also understand that the results of these checks may be disclosed to the firm submitting this application. b) I confirm that the information in this Form is accurate and complete to the best of my knowledge and belief and that I have read the notes to this Form. c) I confirm that I understand the regulatory responsibilities of my proposed role as set out in the Statements of Principle and Code of Practice for Approved Persons (http://fshandbook.info/fs/html/handbook/APER) (http://www.bankofengland.co.uk/PRA)
Tick here to confirm you have read and understood this declaration:
7.01 Candidate’s full name 7.02 Signature
Date†
Please note we will require your actual signature on this declaration and not an e-signature.
19
Section 8 – Overall Financial Position We reserve the right to verify the information given in this section at any time and seek evidence where necessary, to discharge our responsibilities under the Financial Conduct Authority rules. We will obtain a credit reference check on every individual prior to appointment.
8.1 Does your expenditure exceed your income?
Yes
No
8.2 Do your liabilities exceed your assets?
Yes
No
8.3 Do you have any outstanding liabilities that are in arrears or subject to a specially agreed repayment schedule?
Yes
No
8.4 Have you ever had any property repossessed, made the subject of a repossession order, or voluntarily surrendered?
Yes
No
Yes
No
( please provide the address this relates to in the Additional Information page at the back of the application) 8.5 Do you have any properties other than that shown as your current address? If yes, please provide full address(es), including postcode(s), current use of property and dates of occupation in the Additional Information page at the back of the application. 8.6 Are you up to date with all your individual (and if applicable business) tax liabilities? (If no, please provide full details in the Additional Information page at the back of the application)
20
Yes
No
8.7 Financial Status Questionnaire Please provide details of all sources of income and liabilities (including (Including any business liabilities for which you are or may become liable) indicating whether they apply to you individually or jointly.
Financial Status Questionnaire Current monthly income Own monthly income (net of tax)
£
Partner’s monthly income (net of tax) Rental income
£
Other income
£
Please provide details of the nature of this income, eg, investments, pensions, benefits
£
Total Net Monthly Income £
Current monthly expenditure Lender Lender Amount Amount a. Mortgage / Rent £ a. Mortgage / Rent on main residence £
b. Loan repayment
£ c. Credit cards / store cards
£ £ £
d. General household (food, clothing, socialising etc)
£
e. Utilities, Council Tax, Water Rates, Insurance
£
f. Other repayments (specify individually)
£
g. C osts relating to any other properties (including mortgage repayments)
£
h. Debt Management Plans
£ £
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Assets
Amount
a. House(s) Buy to let/additional properties
£ £ £
b. Car(s)
£ £
c. Cash – bank Cash – building society
£ £
d. Investments (Please list individual investments but do not include pensions)
£ £ £
Other
£ Total Assets
£
Liabilities Purpose a. Mortgage
Lender
Value
b. Mortgage Arrears (if applicable)
£ £
c. Loans
£ £ £
d. Bank overdraft Is it authorised?
Yes
No
Yes
No
e. Credit cards
£
£ £ £
f. Personal Guarantees
£
g. Outstanding Financial Services debts
£
h. Income Tax
Date due for payment
£
i. Buy to let/additional properties
£
j. Debt management plan
£ Total Liabilities £
22
Section 9 – Additional Information Please use this space to provide further details on information previously provided in this application
23
Section 10 – Unemployment Details If you have been unemployed or claiming any kind of benefit over the last three years please complete the section below, which will be sent to the DWP if appropriate. If you have been claiming benefit at more than one office, please duplicate this page the relevant number of times (once for each benefit office). All boxes should be completed by you; please ensure that you sign at the bottom of each sheet.
DWP Office Address Post Code Dear Sirs Name
Insurance Number
Address
Date of Birth Dates claiming
Month
Year
From To Postcode
Type of benefit claimed
The above named has applied to this company for a contract and has given their authority for us to approach you in respect of their benefit claims. We would therefore be obliged if you could provide the following information: From Month
To Year
Month
Year
Type of Benefit Claimed
1 2 3 Please advise if your records indicate any areas of concern
Please return this letter in the enclosed pre-paid envelope as soon as possible. Thank you for your co-operation. Yours faithfully Recruitment Administration Team Benefit Office (Signature/Stamp)
I hereby authorise Intrinsic Financial Planning Limited, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) Limited to approach the Department of Work & Pensions for information in respect of any periods of unemployment, benefit claims etc. and I authorise the Department to provide this information.
Date
Signature 24
Recruitment Checklist So that we can process your application accurately and as quickly as possible, please use this checklist and ensure you submit the necessary documents and information with your application. Checks & Documents to Enclose 3 x proof of identification & 1 x proof of address (please do not send original copies) – Such as driving licence, passport, National Insurance Number, National Identity Card and a utility bill dated within the last 3 months Certificates – Copies of all industry qualifications / Higher level qualifications SPS – Required only for Diploma qualified Financial Planners. Financial Planners who are new to the industry will not have a current SPS and will need to apply once FCA authorisation has been granted, and prior to appointment Data Protection Licence (DPL) – In date and in the correct name – https://ico.org.uk/registration/new/about Address History – Full 5 years address history is provided Employment History – Full 5 years employment history is provided and any gaps accounted for Questions – All questions have been answered and additional information provided where necessary Financial Status Questionnaire – Has been completed in full Experian/Credit Report – Enclosed Personal Referees (Not relations) – If currently unemployed or you have gaps in your 3 year employment history Disclosure & Paperwork Required Financial Issues 1. Bankruptcy – Bankruptcy has to be discharged Not applicable Certificate of Discharge Signed statement detailing events and reasons for occurrence Formal list of Creditors Included with the bankruptcy and amounts 2. CCJs – Must be settled or in a repayment plan Not applicable Evidence of up to date repayment plan OR Certificate of Satisfaction - please note any arrangements will need to have been in force for the last 6 months Signed statement detailing events, creditors, amounts and reasons for CCJs occurring 3. Debt Management Plan / Arrangements – Whether through a company or arrangements made directly with creditor(s). Not applicable Evidence of repayment plan and that this is up to date - please note this arrangement will need to have been in force for at least 6 months Signed statement detailing events, creditors, amounts and reasons for debt occurring A copy of the original documentation confirming when the original debt plan/arrangement commenced detailing creditors and amounts 4. Defaults / Mortgage Arrears Not applicable Signed statement detailing events, creditors, amounts and reasons for defaults/mortgage arrears occurring Evidence from each lender that a repayment plan has been put in place which is paid to date or amounts have been cleared - please note arrangements will need to have been in place for at least 6 months
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5. IVA / Trust Deed – Individual Voluntary Arrangement (UK) or Trust Deed (Scotland) – Application may proceed on a case-by-case basis if still in force. Not applicable Signed statement detailing events, creditors, amounts and reasons for IVA/Trust Deed occurring. A statement from the insolvency practitioner should be included, or a copy of their report Formal list of creditors included with IVA/Trust Deed and amounts - please note these arrangements will need to have been in place for at least 6 months Complaints 1. Complaints Not applicable Any documentation held Details of complaints, dates and where authorised when it/they occurred Client names and outcomes / redress amounts Disciplinary 2. Warnings / Breaches / Investigations Not applicable Any documentation held Details of Warning / Breach / Investigation, date and where authorised when it occurred Outcome, including any additional training / remedial action 3. Suspension / Termination Not applicable Any documentation held Details of Suspension/Termination, date and, where authorised, when it occurred Outcome, including any additional training / remedial action Convictions 1. Convictions (Excluding motoring unless resulted in a ban) – All convictions regardless of whether they are now spent Not applicable Any documentation held Details of sentence or penalty Directorships 1. Directorships – This question specifies ‘Have you ever…’ Not applicable All directorships should be disclosed in application to include future intentions, any liabilities and how this will fit in with your Intrinsic / Positive Solutions contract or will be kept separate and distinct 2. Liquidations / Company in Administration Not applicable Liquidator’s report Details of company name and number, date and how / why it occurred Details of any enforcements as a result Regulatory Experience Please can you provide copies of your Persistency/Cancellation levels and data concerning your suitability of advice checks. If applicable copy correspondence relating to any complaints either upheld or not upheld, copies of any 1:1 reviews, compliance visits or annual inspections.
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Section 11 – Declaration
IMPORTANT INFORMATION It may be a criminal offence to provide false or misleading information to the Financial Conduct Authority or Intrinsic Financial Planning Limited, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) Limited. It is, therefore, vital that all questions in this application form have been answered fully and accurately. I understand that Intrinsic Financial Planning Limited, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) Limited are part of the Intrinsic Financial Services Group and that any information contained in the application or otherwise supplied by me/us may be shared with Intrinsic Financial Services Group for the purposes of processing this application and the Appointed Representative (if applicable) I am joining. I confirm that: –
The information given in this application is accurate and complete, and all relevant details have been disclosed.
– I understand that the information disclosed may be used as the basis of deciding if I will be offered a contract with Intrinsic Financial Planning Limited, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) Limited.
–
I give my permission for Intrinsic Financial Planning Limited, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) Limited to undertake a credit search with a licensed credit reference agency and acknowledge that the credit reference agency will keep a record of this search and may share this with other businesses.
– I give my permission for Intrinsic Financial Planning Limited, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) Limited to take up any references that it considers appropriate in order to consider this application and I authorise that source to release the information requested. This may include contacting any Lender, Bank, Building Society, Accountant, Solicitor, past and present Employers, Unemployment Benefit Office or any other relevant party. – I understand that if there is any material change to my circumstances after the date of this application, I will promptly inform Intrinsic Financial Planning Limited, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) Limited.
–
I understand I will be invited to attend training courses at a place advised by Intrinsic Financial Planning Limited, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) Limited and that this invitation does not imply a commitment from Intrinsic Financial Planning Limited, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) Limited to offer a contract upon completion of the training; nor does it imply a commitment on your part to proceed with your application. However, successful completion of the training courses is a precondition of the offer of a contract.
–
I confirm I will enter into an agreed repayment schedule, or full and final settlement, with any Financial Services Company, to repay any related Financial Services debt.
–
I understand I am not authorised to represent Intrinsic Financial Planning Limited, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) Limited in any way until written confirmation has been provided by Intrinsic Financial Planning Limited,
–
If authorisation is given by Intrinsic Financial Planning Limited, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) Limited, I will, at all times, comply with the FCA rules, and Intrinsic Financial Planning Limited, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) Limited policies and procedures.
–
I understand that Intrinsic Financial Planning Limited, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) Limited will conduct an identity check from the information I have provided on my application form.
Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) Limited.
– I understand that Intrinsic Financial Planning Limited, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) Limited may request a Disclosure and Barring Service check to be conducted following the information I have provided on my application form. – I understand that Intrinsic Financial Planning Limited, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions Limited will obtain a Disclosure Scotland check following the information provided on my application form. Data Protection
Under the Data Protection Act 1988 we have to tell you who’s responsible for deciding how your personal information will be used. The information you provide on this form including any sensitive personal details for example criminal convictions, will be used by Intrinsic Financial Planning Limited, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) Limited to assess your suitability for the contract you have applied for. This may include undertaking credit checks and seeking references for the purpose of verification, identification and in accordance with Intrinsic Financial Planning Limited, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) Limited regulatory requirements to ensure that you are fit and proper to perform the activities permitted under the contract. We may share your relevant personal information with other companies that Intrinsic Financial Planning Limited, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) Limited are or become associated with and agents acting on behalf of Intrinsic Financial Planning Limited, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) Limited to comply with our regulatory obligations and for ongoing administration, management information and marketing purposes. For the avoidence of doubt this may include other Old Mutual group entities. The personal data you provide will be used and stored in accordance with the Data Protection Act 1998. To understand exactly what data we hold, why we hold it and your rights under the Data Protection Act 1998 our Fair Processing Notice can be viewed at www.intrinsicfs.com please view Fair Processing Notice link.
Declaration of this application. I accept the terms and conditions of this application to join Intrinsic Financial Planning Limited, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) Limited. Full name of person submitting the application Signature
Signature of Intrinsic Regional Director/ Principle of Appointed Representative Firm
Date Name of your Intrinsic Regional Director Please note - If you add an e-signature we will require a copy of the document with your actual signature on it. 27
