Sole Trader
Appointed Representative Application
Guidance Notes
Please complete all sections of this form using BLOCK CAPITALS and black ink. Please read through all the questions in their entirety before
attempting to answer them and all explanatory notes carefully before completing this form.
All dates should be written in the dd/mm/yyyy format. If a question is NOT APPLICABLE, please indicate clearly. Where a No/Yes answer is required,
please place an ‘X’ in the appropriate box. For detailed answers please use the Supplementary Information Sheets at the back of the form. Any
additional information submitted with this form must be signed and dated.
Any information supplied on this form will be subject to verification. If this reveals that relevant information has been omitted, either
intentionally or through lack of care, or that the information is false, inaccurate or misleading, processing times will lengthen and in some
cases the application may be rejected.
At any time after receiving an application and before determining whether the application is to be accepted, HomeLoan Partnership may require the
firm to provide further information.
In all circumstances, disclosures must be full, frank and unambiguous. If you are in doubt about the relevance of any information, such information
should be included.
HomeLoan Partnership must be informed immediately of any changes to the information provided in this application form which arise before
the application has been determined. All changes must be communicated to HomeLoan Partnership in writing. Failure to notify
HomeLoan Partnership may result in a delay in processing and/or rejection of the application.
Section One—Firm Details
This section should include the details of the firm and yourself as the Sole Trader. This will be the primary contact information that we will
use when processing your application.
Full Name Of The Firm:
Your name:
Title:
Mr
Mrs
Miss
Ms
Other
Surname:
Forenames:
3) Office Address
Office Number:
Postcode:
Office Name:
Street Name:
Town/City:
County:
Your Direct Business Telephone Number (including STD code):
Your Business Mobile Phone Number:
Your Business Fax Number (including STD Code):
Main Business Email Address:
Website Address:
Head Office telephone number (including STD Code) (If different from your direct telephone number)
2
Section Two—Personal Details
Home Address
Please provide a full 3 year address history
Current Address:
When did you move to your current address?
House Number:
Postcode:
Street Name:
Town / City:
County:
Telephone Number (including STD Code):
Mobile Phone Number (if different from your business Mobile number):
Email Address (if different from that of the firm):
Previous Address [1]:
Dates of occupancy:
From:
To:
House Number:
Postcode:
Street Name:
Town / City:
County:
Previous Address [2]:
Dates of occupancy:
From:
To:
House Number:
Postcode:
Street Name:
Town / City:
County:
Please use the Supplementary Information page to supply further address information
Proof of Identity and Address
Please provide a photocopy of the following:
Either your Passport or Photo-Card Driving Licence; and
Proof of Address such as a copy of a Utility Bill or Bank Statement dated within the last 3 months, or your most recent Council Tax Demand.
Please indicate whether these are:
Enclosed with Application
To follow
Other Details
Date of Birth:
Place of Birth:
Nationality:
National Insurance Number:
Previous Name (any former surnames of forenames; or any other names known by):
Surname:
ALL Forenames:
Date of Change:
Reason for Change:
3
Section Three—Your Experience
Qualifications
Please indicate the qualifications that you hold:
CeMAP Paper 1
FPC / CFP Paper 1
Adv CeMAP
CeMAP Paper 2
FPC / CFP Paper 2
CeMAP Bridge
CeMAP Paper 3
FPC / CFP Paper 3
MAQ
Please detail below any other relevant qualifications such as Lifetime / Commercial / Insurance qualifications:
Please supply copies of your qualification certificates.
Please indicate whether these are:
Enclosed with Application
To follow
Experience
How long have you been advising on mortgages and / or insurance?
What is your competency status in these areas?
Mortgages:
Years:
Months:
Trainee
Competent adviser
Insurance:
Years:
Months:
Trainee
Competent adviser
/
If Competent Adviser, what date did you achieve Competent Adviser Status?
/
If you have previously been competent but have had a gap in advising, when were you last deemed competent?
/
/
Have you ever been registered as an individual on the FCA / FSA Register?
No
Yes
If ‘Yes’ please provide your Individual Reference Number (IRN):
Section Four—Your Business and Finance
Is your firm a new start up?
No
Yes
If ‘No’ when did your firm begin trading?
/
Does the firm currently carry on insurance and / or mortgage business in the United Kingdom?
If yes, when did the firm begin carrying on Mortgage Business?
/
When did the firm begin carrying on Insurance business?
No
Yes
and;
/
Cross ONE of the choices provided below which best describes the main nature of your business:
Mortgage Broker
Other
Insurance Broker
Packager
Estate Agent
Please specify
How many of your staff (including principals / owners) are involved in mortgage advising and arranging?
How many of your staff perform non-advising roles (e.g. Administrators / Para planners)?
4
Financial Information
Is the firm up to date with its dealings with the HM Revenue & Customs?
No
Yes
How are your accounts dealt with?
Self-Assessment
By accountant
Please indicate what your Account Reference Date is?
(The Accounting Reference date is the date to which the firm prepares its annual accounts)
Is the firm VAT Registered
No
Yes
If Yes, please state VAT number:
Please supply copies of your most recent one of the following;
Accounts; or
Inland Revenue Approved Accounts; or
•
•
•
Self-Assessment Forms
Please indicate whether these are:
Enclosed with Application
To follow
If, for any reason, you cannot supply these, please explain in the Supplementary Information section.
Please supply a copy of the firm’s Business Plan / Forecast for the next 12 months.
Please indicate whether this is:
Enclosed with Application
To follow
A simple template is available for your use if needed. Please let us know if you require this.
Does the firm charge a fee for mortgage advice?
Please indicate whether this is:
No
Yes
Enclosed with Application
To follow
Please state your total turnover for the last financial year:
If Yes, please supply your fee agreement.
£
Please indicate what percentage of your turnover was made up of Broker Fees:
%
Bank Account Details (for payment of procuration fees and commissions)
Account Name:
Sort Code:
Account Number:
Consumer Credit Licence
You are required to hold a Consumer Credit Licence (CCL) covering at least Categories C, D1 & E1. Please provide your licence number and
enclose a copy of the certificate when returning this application.
Licence Number:
Please indicate whether this is:
Enclosed
To follow
Please list any additional trading names the firm uses: (Please note the CCL should show ALL trading names / styles)
If you have more trading names, please detail in the Supplementary Information section.
Data Protection
It is a legal requirement that all firms that hold personal details, whether written or computerised, must be registered with the Information
Commissioner’s Office. Please enter your firm’s registration number below and enclose a copy of the certificate when returning this form.
Licence Number:
5
Please indicate whether this is:
Enclosed
To follow
Regulated Status
Has the firm ever been registered with the FCA / FSA?
No
Yes
If yes, what is/was the Firm Reference Number (FRN)?
Has the firm ever had a regulatory visit, desktop audit or any other supervision intervention?
No
Yes
If Yes, please supply a copy of the report or findings or any correspondence.
Please indicate whether this is:
Enclosed with Application
To follow
Professional Reference
Please provide details of your current Accountant, your Solicitor or someone who has known you in a professional capacity who could provide a
reference.
Full Name Of Firm:
Dates they have known or been associated with you?
Principal Contact:
Title:
Mr
From:
Mrs
To:
Miss
Ms
Other
Surname:
Forenames:
Office Number:
Postcode:
Office Name:
Street Name:
Town / City:
County:
Telephone Number including STD code:
Fax Number including STD code:
Email Address
6
Section Five—10 Year Employment History
We need to compile a referencing file under strict FCA guidelines to demonstrate that the applicant is ‘Fit & Proper’ to be authorised in financial
services.
To do so we need a full and accurate 10 year history from which we will obtain references. Please provide details of your employment/selfemployment history in reverse chronological order (i.e. most recent first). Any gaps of more than 1 calendar month should be accounted. Please note
for periods of unemployment (whether claimed or unclaimed full details need to be shown in the Unemployment Details section at the back of this
application). If you were in full time education please show the relevant details in this Employment History section including contact details.
If there is insufficient space to complete a 10 year history, please use the Supplementary Information Section at the rear of the form.
Current / Most Recent Employment:
Please confirm that it is acceptable to contact this company for a reference:
Dates of employment
Employed
From:
Self Employed
/
/
No
Yes
/
To:
/
Full-Time Education
If self-employed, please provide details of accountant or any company that you are contracted to.
Contact Name
Firm Name:
Nature of Business:
Is / Was the firm regulated by a regulatory body?
No
Yes
If ‘Yes’ please state
Was the firm an Appointed Representative?
No
Yes
If ‘Yes’, name principal
Position Held:
Responsibilities:
Reason for leaving:
Contact Details
Office Number:
Postcode:
Office Name:
Street Name:
Town / City:
Telephone Number (including STD code):
Fax Number (including STD code):
Email Address:
NOTES
7
County:
Previous Employment [1]:
Please confirm that it is acceptable to contact this company for a reference:
Dates of employment
Employed
From:
Self Employed
/
/
No
Yes
/
To:
/
Full Time Education
If self-employed, please provide details of accountant or any company that you are contracted to.
Contact Name
Firm Name:
Nature of Business:
Is / Was the firm regulated by a regulatory body?
No
Yes
If ‘Yes’ please state
Was the firm an Appointed Representative?
No
Yes
If ‘Yes’, name principal
Position Held:
Responsibilities:
Reason for leaving:
Contact Details
Office Number:
Postcode:
Office Name:
Street Name:
Town / City:
County:
Telephone Number including STD code:
Fax Number including STD code:
Email Address:
NOTES
8
Previous Employment [2]:
Please confirm that it is acceptable to contact this company for a reference:
Dates of employment
Employed
From:
Self Employed
/
/
No
Yes
/
To:
/
Full Time Education
If self-employed, please provide details of accountant or any company that you are contracted to.
Contact Name
Firm Name:
Nature of Business:
Is / Was the firm regulated by a regulatory body?
No
Yes
If ‘Yes’ please state
Was the firm an Appointed Representative?
No
Yes
If ‘Yes’, name principal
Position Held:
Responsibilities:
Reason for leaving:
Contact Details
Office Number:
Postcode:
Office Name:
Street Name:
Town / City:
Telephone Number including STD code:
Fax Number including STD code:
Email Address:
NOTES
9
County:
Previous Employment [3]:
Please confirm that it is acceptable to contact this company for a reference:
Dates of employment
Employed
From:
Self Employed
/
/
No
Yes
/
To:
/
Full Time Education
If self-employed, please provide details of accountant or any company that you are contracted to.
Contact Name
Firm Name:
Nature of Business:
Is / Was the firm regulated by a regulatory body?
No
Yes
If ‘Yes’ please state
Was the firm an Appointed Representative?
No
Yes
If ‘Yes’, name principal
Position Held:
Responsibilities:
Reason for leaving:
Contact Details
Office Number:
Postcode:
Office Name:
Street Name:
Town / City:
County:
Telephone Number including STD code:
Fax Number including STD code:
Email Address:
NOTES
10
Section Six—Assets & Liabilities
Please complete the below table which identifies the most common personal assets and liabilities. Others which are not specifically identified should
be included with a short description. Investments should include only readily realisable securities and unit trusts.
You should include the current value of any investment used as a vehicle to repay a mortgage loan. You should not include the value of any personal
pensions nor any value for the goodwill or assets of your firm, unless it is in the form of a readily realisable security.
If you have given any personal guarantees to a third party, e.g. to secure business liabilities these should be described and the maximum liability
disclosed. Any other contingent liabilities should also be included; e.g. prospective calls on Lloyd's named.
Note that in the case of jointly owned assets and liabilities, only the proportion that directly applies to yourself should be detailed, but please explain in
the notes section what proportion you own.
Assets
Value of house
Value
Liabilities
Value
£
Outstanding Mortgage(s)
£
Total value of other properties in Buy-to-Let
(Please provide full details and addresses in the table
below)
£
Outstanding Mortgage(s)
(Please provide full details for each address
in the table below)
£
Office
£
Motor Vehicles (estimated market value)
£
Motor vehicle finance/loan
£
Investments (Note, we may ask for verification)
£
Overdraft(s)
£
Bank Balance(s)
£
Credit card balance(s)
£
Cash Deposits (Note, we may ask for verification)
£
Other (please specify)
£
Debtors
£
£
£
£
£
Other (Please specify below)
TOTAL ASSETS
£
TOTAL LIABILITIES
£
2nd Household Income? (Please provide details in
the notes i.e. Spouses income/2nd
occupation etc.)
£
TOTAL ASSETS - LIABILITIES
£
Note that we may ask for further validation of declared assets including but not limited to mortgage and savings accounts statements
and may carry out additional checks to validate property prices, land registry ownership etc.
Notes :
Buy to Let Properties
Address
11
Post Code
Share
Value
Mortgage
Rent (per year)
Section Seven - Disclosure
Answer the questions by crossing the relevant box. Where the answer to any of the questions is Yes, please give complete details on the
Supplementary Information Sheet.
Do you have any convictions in respect of any criminal offence of dishonesty, fraud, financial crime or violence? Spent convictions for
relevant offences must be disclosed in accordance with the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975.
No
Yes
Are you currently the subject of any current criminal or civil proceedings?
No
Yes
Do you have any unspent convictions in respect of any offence under legislation relating to?
a) Banking?
No
Yes
b) Financial Services?
No
Yes
c) Companies Act?
No
Yes
d) Insurance?
No
Yes
e) Consumer Protection?
No
Yes
Are you currently subject to any charges, civil proceedings or litigation in respect of offences under legislation relating to?
a) Banking?
No
Yes
b) Financial Services?
No
Yes
c) Companies Act?
No
Yes
d) Insurance?
No
Yes
e) Consumer Protection?
No
Yes
Are there currently any outstanding judgment debts or awards (whether in full or in part) against you (e.g. County Court Judgments) or have
you been in arrears or default with creditors during the last 2 years?
No
Yes
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
you or to avoid publicity?
No
Yes
Have you or any firm of which you have been a director, partner or controller, in the last 5 years been the subject of any:
a) Bankruptcy?
No
Yes
b) Insolvency?
No
Yes
c) Liquidation Proceedings?
No
Yes
d) Dissolution?
No
Yes
e) Proposal to Strike Off?
No
Yes
Please provide details of all existing / previous authorisations or appointments held by you (eg. Directorships / Partnerships) below and provide
full information in the Supplementary Information section if any of these companies have ceased to trade.
Have you ever had the right to carry on any trade, business or profession for which specific licence, authorisation, registration membership
or other permission is required?
a)
Refused
No
Yes
b)
Restricted
No
Yes
c)
Terminated
No
Yes
Are you now or have you ever been the subject of any disciplinary / enforcement action by a regulator, government body, agency, employer
or other FCA / FSA authorised firm?
No
Yes
12
Has any firm where you were an owner, shareholder or director ceased trading in circumstances in which any of its creditors did not
receive full payment?
No
Yes
Have you ever had a complaint registered against you?
No
Yes
If Yes, please provide full details in the Supplementary Information section. Please ensure this includes the nature of the complaint and whether or not
it was upheld.
Have you, or any firm that you have worked for, been removed from a lenders panel?
No
Yes
Have you as an individual, or a company within which you have worked and/or been authorised ever been involved in discussions or
correspondence with the regulator over any investigation or disciplinary matter or routine audit including TCF or thematic audits whether in
person or desk-based telephone audit? If yes, please provide details in the Supplementary Information section.
No
Yes
Are you, or have you ever been the subject of an investigation by the FCA, any other regulator, network or employer?
No
Yes
Do you have any other evidence of Training & Competence (including attainment of CAS if applicable) that could be provided to us?
No
Yes
Have you an application pending for any other network or has any previous application been declined?
No
Yes
Please confirm whether you have acted as an adviser in ANY regulated activity that is not specifically detailed on the application form?
No
Yes
If you have answered ‘yes’ to any question, please ensure you provide additional information in the Supplementary
Information Section.
Section Eight - Additional Information
Security Question
For the purposes of information security, please provide a security question and answer. Please ensure this is something memorable
Question:
Answer:
Document Checklist
We will require the following documents during the referencing process (as appropriate). Please enclose as many as possible at the point of
application.
Consumer Credit Licence
Copy of Passport / Drivers Licence
Data Protection Certificate
Proof of Address
Regulator Report (if applicable)
Fee Agreement (if applicable)
Copies of qualification certificates
Most recent Accounts/ Confirmed Self-Assessment
Latest 3 Months Bank statements
Personal Credit Report
1 Year Business Plan / Forecast
Any supplementary information where
necessary
£50 Application Fee Payment
Cheque enclosed / BACs payment made
13
OR
Please call to arrange credit/debit card payment
Section Nine - Declaration
For the purposes of complying with the Data Protection Act, the personal information provided in this form will be used by HomeLoan Partnership, or its
designated Appointed Representative, to discharge its obligations as a Principal Network as defined by the FCA and other relevant legislation, and will
not be disclosed for any other purpose without the permission of the applicant.
By completing and signing this application form the adviser agrees to be bound by FCA regulations (including the provisions relating to appropriate
arbitration / ombudsman schemes) and the terms of appointment and procedures notified by HomeLoan Partnership, as amended from time to time.
I declare that the information supplied in this form is complete and correct to the best of my knowledge and belief, and that
there are no other relevant facts of which HomeLoan Partnership should be aware. I understand that checks may be made to
verify the answers I have given. I also authorise HomeLoan Partnership to make such enquiries and seek such further
information as it thinks appropriate from time to time.
I understand that the information I have provided may be disclosed to one or more licensed credit reference agencies for the
purpose of allowing a search of their records and that the credit reference agencies may keep a record of HomeLoan
Partnership’s enquiry.
Signature:
Date:
Print full name:
Now please scan and email the Application Form and any supporting documents to
[email protected] or to your contact in Member Support Team.
Applications can also be sent by post to:
HomeLoan Partnership
Pharos House
67 High Street
Worthing
West Sussex BN11 1DN
If you have any questions about the completion of this Application Form please call 01903 602664.
14
Supplementary Information
Please supply any additional information to support your application below. Also ensure you enter the section number to which the information
relates. Where applicable, please include:
•
•
•
•
15
The date(s) of the event;
The amount involved
The outcome; and
Any relevant or explanatory circumstances
Supplementary Information—Continued
16
Unemployment Details Section
Please provide details of any periods of Unemployment in the table below and indicate whether or not you were claiming any
benefits during these periods.
If you were claiming benefits please also complete the next page to enable us to obtain verification from the Department of
Work and Pensions.
From
Month
1
2
3
4
5
6
7
8
9
10
17
To
Year
Month
Benefits Claimed
Year
Yes
No
Unemployment Authorisation Form
If you have been unemployed or claiming any kind of benefit over the last three years please complete the details below which will be sent to
the DWP if appropriate. If you have been claiming benefit at more than one office, please copy this page the relevant number of times (1
form for each benefit office). All boxes should be completed by you and that you sign the authorization below.
I hereby authorise HomeLoan Partnership to approach the Department of Work and Pensions for information in respect of any periods of
unemployment, benefit claims etc. and I authorise the department to provide this information.
Signature
Date
DWP Office Address
Postcode
Dear Sirs
Name
NI Number
Address
Date of birth
Postcode
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 grateful if you could provide the following information.
From
Month
Year
To
Month
1
2
3
Please provide any information which you feel is relevant.
Please return this letter in the enclosed pre-paid envelope as soon as possible.
Thank you.
Yours faithfully
Member Support Team
Benefit Office (Signature/Stamp)
Year
Type of Benefit
19
Instruction to your
bank or building society to
pay by Direct Debit
Please complete the whole form using a ball point pen & post to:-
H L Partnership Limited
Pharos House
High Street
Worthing
West Sussex
BN11 1DN
Service user number
4
3
7
2
9
9
Name(s) of account holder(s)
Reference
Bank/building society account number
Instruction to your bank or building society
Please pay H L Partnership Limited Direct Debits from the account
detailed in this Instruction subject to the safeguards assured by the
Direct Debit Guarantee. I understand that this Instruction may remain
with H L Partnership Limited and, if so, details will be passed
electronically to my bank/building society.
Branch sort code
Name and full postal address of your bank or building society
To: The Manager
Bank/building society
Address
Signature(s)
Postcode
Date
Banks and building societies may not accept Direct Debit Instructions for some types of account
This guarantee should be detached and retained by the payer.
The Direct Debit
Guarantee
• This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits
• If there are any changes to the amount, date or frequency of your Direct Debit H L Partnership Limited will notify you 10
working days in advance of your account being debited or as otherwise agreed. If you request H L Partnership Limited to
collect a payment, confirmation of the amount and date will be given to you at the time of the request.
• If an error is made in the payment of your Direct Debit, by H L Partnership Limited or your bank or building society, you are
entitled to a full and immediate refund of the amount paid from your bank or building society
– If you receive a refund you are not entitled to, you must pay it back when H L Partnership Limited asks you to
• You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be
required. Please also notify us.
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