IAR Application Form
To become an Introducer Appointed Representative of Thistle
Insurance Services Ltd
Introducer Appointed Representative Name
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By becoming an Introducer Appointed Representative (IAR) of Thistle
Insurance Services Ltd you have the opportunity to add value to your
current business. You are able to do this by being authorised to introduce
customers to us.
An IAR is restricted to introducing customers to the Principal (Thistle Insurance
Services Ltd) and distributing certain kinds of marketing material only. Whilst
this comes under the definition of a regulated activity, it is an option for firms
that do not want the responsibility of being directly regulated by the FCA, or
involved in the administration of the insurance product. They cannot take
premiums but they can pass on a customer’s details to the Principal.
This application form is intended for organisations or companies that would
like to be considered for Introducer Appointed Representative status on
behalf of Thistle Insurance Services Ltd
More information about regulation is available within our ‘IAR/AR Guide to
Regulation’ document or via the FCA website at www.fca.org.uk.
Please complete all sections of the application form. Once
completed and signed, please return the form in the post to:
Quality Assurance Manager
Thistle Insurance Services Ltd Southgate House
Southgate Street
Gloucester
GL1 1UB
Or Email: [email protected]
FOR OFFICE USE ONLY:
Thistle Reference
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Thistle Insurance Services Limited is authorised and regulated by the Financial Conduct Authority. Lloyd’s Broker. Registered in England under No. 00338645
Registered office: 68 Lombard Street London EC3V 9LJ.
IAR Application Form
To become an Introducer Appointed Representative of Thistle
Insurance Services Ltd
Section 1 – Company Details
Company Name
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Trading Name
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Company
Registration No.
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Date
Established
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Trading Address
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Registered
Office
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Tel No.
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Tel No.
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Fax No.
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Fax No.
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Email Address:
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Website:
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Number of staff (working for the company):
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Number of staff who will be involved in the IAR Process:
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Principal Business Activity
Contact Name
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Please list below the names of ALL directors, Partners, Senior Managers and/or controller within the business:
Full name
Position Held
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Thistle Insurance Services Limited is authorised and regulated by the Financial Conduct Authority. Lloyd’s Broker. Registered in England under No. 00338645
Registered office: 68 Lombard Street London EC3V 9LJ.
IAR Application Form
To become an Introducer Appointed Representative of Thistle
Insurance Services Ltd
Section 2 – Additional Company Information
Are you associated with any other firm of
brokers or intermediaries?
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If yes, please provide
details
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What is the name of your Lead Principal? (if
applicable)
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Please list the products that you
currently Introduce on behalf of this
principal?
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Do you have more than one branch that
requires IAR facilities?
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If yes, please provide
details
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Do you offer (or intend to offer) any form of
Consumer Credit?
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If yes, please provide
details
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Are you registered under the Consumer
Credit Act?
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If yes, what is your
registration no.?
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*Please note that it is your responsibility to register yourself or your company under the Consumer Credit Act with appropriate permissions from
the FCA. Thistle Insurance Services Ltd do not provide you with permission to undertake consumer credit activities and accept no responsibility or
liability regarding any consumer credit activity that you provide or intend on providing.
Are you registered under the Data Protection
Act?
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Do you have a Business Continuity Plan in
place?
Choose an item.
If yes, when was it last
tested or due to be
tested?
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Are there any conflicts of interest that will
arise as a result of the relationship
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If yes, please provide
details
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Thistle Insurance Services Limited is authorised and regulated by the Financial Conduct Authority. Lloyd’s Broker. Registered in England under No. 00338645
Registered office: 68 Lombard Street London EC3V 9LJ.
IAR Application Form
To become an Introducer Appointed Representative of Thistle
Insurance Services Ltd
Section 3 – FCA Registered Details
We need to provide the following information to the FCA who keep a public record of authorised firms and introducer appointed representatives
Are you currently registered with the FCA for
any activities?
Choose an item.
If yes, please provide
your FCA registration
no.
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Has your company ever been regulated by
the FCA and had their regulatory status
revoked?
Choose an item.
If yes, please provide
details
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Legal Status of Firm – Please tick one of the following which best describes the legal status of your business:
Sole Trader*
No
Limited Partnership
No
Public Limited Company
No
Private Limited Company
No
Limited Liability Partnership
No
Partnership (other than limited liability)
No
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Other
*If applicant is a Sole Trader, please provide:
National Insurance
No.
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Your date of birth
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Section 4 – Thistle Insurance Services Products
Please tick the boxes below to indicate the products you would like to introduce to customers;
Cycle Insurance
Choose an
Commercial Lines Insurance
item.
Choose an
item.
Musicians Insurance
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Personal Lines Insurance
item.
Choose an
item.
Photography Insurance
Choose an
Other (Please state below)
item.
Choose an
item.
Caravan Insurance
Choose an
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item.
Tenants Contents Insurance
Choose an
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item.
Thistle Insurance Services Limited is authorised and regulated by the Financial Conduct Authority. Lloyd’s Broker. Registered in England under No. 00338645
Registered office: 68 Lombard Street London EC3V 9LJ.
IAR Application Form
To become an Introducer Appointed Representative of Thistle
Insurance Services Ltd
Section 5 – Initial declaration of Fit and Properness for IARs
This section needs to be completed by the Managing Director, Managing Partner or Proprietor of the proposed Introducer Appointed
Representative;
Has any director, partner or manager personally or by association had any agency with any insurer or cancelled for
any reason other than lack of support?
Choose an item.
Has a petition for bankruptcy or compulsory winding up of the firm ever been presented?
Choose an item.
Has the firm had a receiver or administrator appointed, failed to satisfy a debt adjudged due, or come to a
compromise or similar arrangement with any of its creditors?
Choose an item.
Has the firm been a defendant in any criminal or civil proceedings or arbitration within the last 5 years or is any
unsatisfied judgement debt or award outstanding against it?
Choose an item.
Have any settlements been entered into in the last 5 years, whether or not on an ex gratia basis, to avoid
legal action being brought against the firm or to avoid publicity?
Choose an item.
Has the firm at any time been convicted of fraud or other dishonesty or an offence under legislation (whether or
not in the UK) relating to companies, building societies, industrial and provident societies, credit unions, friendly
societies, insurance, banking or other financial services, insolvency, customer credit or consumer protection?
Choose an item.
Is the firm involved as a defendant in any proceedings, investigations or other events referred to in any of the
above questions which are not yet determined? Or are any such proceedings, investigations or other such
events pending?
Choose an item.
Has the firm ever been refused, or had revoked, any licence, membership, authorisation, registration or any
other permission granted by a financial services regulator in the UK or overseas?
Choose an item.
Are there any other significant events regarding the firm or companies in the firms group that might adversely
affect the Principal decision to accept this firm as an Introducer Appointed Representative?
Choose an item.
Thistle Insurance Services Limited is authorised and regulated by the Financial Conduct Authority. Lloyd’s Broker. Registered in England under No. 00338645
Registered office: 68 Lombard Street London EC3V 9LJ.
IAR Application Form
To become an Introducer Appointed Representative of Thistle
Insurance Services Ltd
If you have answered ‘Yes’ to any of the questions in section 5, please provide further information below including any dates, amount
involved, the outcome plus any relevant or explanatory circumstances
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Thistle Insurance Services Limited is authorised and regulated by the Financial Conduct Authority. Lloyd’s Broker. Registered in England under No. 00338645
Registered office: 68 Lombard Street London EC3V 9LJ.
IAR Application Form
To become an Introducer Appointed Representative of Thistle
Insurance Services Ltd
Section 6 – Introducer Appointed Representative Suitability considerations
We might check the following processes in order to assess your suitability to be or to continue to be an Introducer Appointed Representative of
Thistle Insurance Services Ltd;
Complaints regarding the insurance product and/or the sales process should be directed as per the
policy wording. We would want to ensure however that you have an effective complaints procedure
in place for dealing with your own product related complaints – as an inability to deal with this could
affect our reputation or be directed towards us as the insurance provider.
1.
Complaint handling
2.
Training and Competence
3.
Financial Crime Prevention
One of the FCA’s objectives is the reduction of financial crime. They therefore expect to see that you
have controls in place to prevent financial crime wherever applicable.
4.
Business Continuity
Management
One of the main objectives of the FCA is protection for consumers. The FCA therefore expect that firms
have adequate plans to cope with disruption to the business so customers are not affected to their
financial detriment. For example if fire or flood damaged the business premises, how would the
business continue with minimal disruption to its customers?
5.
Information security/Data
Protection
This has links to Financial Crime Prevention but mostly relates to adherence to the Data
Protection Act.
The FCA require that all staff directly involved in general insurance activity are of good repute and
that they are competent to carry out their jobs and remain so throughout their employment.
Section 7 – Additional information
Please use the space below to provide any additional information relevant to the application (including the question number
if applicable) to become an Introducer Appointed Representative
Click here to enter text.
Thistle Insurance Services Limited is authorised and regulated by the Financial Conduct Authority. Lloyd’s Broker. Registered in England under No. 00338645
Registered office: 68 Lombard Street London EC3V 9LJ.
IAR Application Form
To become an Introducer Appointed Representative of Thistle
Insurance Services Ltd
Section 8 – Declaration (please tick)
I/ We hereby make an application to become an Introducer Appointed Representative (IAR) of Thistle Insurance
Services Ltd. (the application is subject to suitability checks being carried out by Thistle Insurance Services Ltd)
I/ We have highlighted in section 4 the products that we wish to act as an IAR for
I/ We will update Thistle Insurance Services Ltd of any changes in our business and the persons involved in selling
and providing general insurance that is relevant to this agreement
I/ We confirm that the company is up to date with its dealing with HMRC & Companies House with regards to
relevant submissions
I/ We confirm that the I am/We are happy for Thistle to carry out the relevant suitability checks detailed in section
6 when considering this application to be an Introducer Appointed Representative and in any future compliance
audits
I/ We confirm that the information declared is true and that any other relevant information has not been
withheld
In connection with this application, Thistle Insurance Services Ltd may carry out a search with Experian, a licensed Credit Reference Agency, and
may also ask to review your most recent set of accounts to assess the financial stability and cash flow of the business in line with FCA guidance.
I/We hereby expressly consent to such search or check. Should this application be successful, I/we agree to
adhere to and be bound by Thistle Insurance Services Ltd’s terms and Conditions of appointment
To fulfil our Data Protection responsibilities please provide a copy of your Company Data Protection Policy wording and confirm below:
I have enclosed a copy of our
data protection policy
(please tick)
Name
Signature
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If you do not have a data protection
policy and cannot provide this (please
provide comments)
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Position Held
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Date
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Thistle Insurance Services Limited is authorised and regulated by the Financial Conduct Authority. Lloyd’s Broker. Registered in England under No. 00338645
Registered office: 68 Lombard Street London EC3V 9LJ.