intrinsic individual application form - restricted 12 · 2016. 4. 11. · cemap 2 cemap 3 cemap...

FOR INTERNAL USE ONLY June 2015

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 considers the following of utmost importance: FCA

• 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 Other names are known, or have previously been known, by

any other names or have a former name(s) or surname(s), please enter fulldetails

Date of name change

Reason for name change

1.3 Contact details 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

Dates at this address From

To

2

Month Year

Former name(s)

Yes No N/A

Address

Town

2 Address

Town

County

Postcode

1

From

To

1.5 Previous address(es) If you have not resided at your current address for more than three years, please enter previous addresses.

Dates at this address Month Year

1.6 Date of birth

1.7 Long Passport Number (including 2 numbers at the end)

(This number can be found at the edge of the passport page)

1.8 Expiry Date on Passport

1.9 Issue Date on Passport

1.10 National Insurance number

1.11 If you have a temporary National Insurance number or no National Insurance number, have you applied for a permanent number?

1.12 Nationality

1.13 Place of birth

1.14 If born outside the EU, how long have you lived in the UK?

1.15 Driving licence number

1.16 Postcode on driving licence

Day Month Year

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.

1.17 Are you applying as:

Selling Principal – Mortgage Adviser

Non-Selling Principal

Registered Individual – Financial Planning Adviser

3

Selling Principal – General Insurance Adviser Selling Principal – Financial Planning Adviser

Registered Individual – Mortgage Adviser

Registered Individual – General Insurance Adviser

County

Postcode

Month Year

From

To

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

1.18 Are you applying to join:

An existing Firm

Name of Firm

A new Applicant Firm

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

FPC1

FPC2

FPC3

CF 1

CF 2

CF 3

CF 4

CF 5

CF 6

MAQ

IFS

CeMAP 1

CeMAP 2

CeMAP 3

CeMAP Bridge

CeFA 1

CeFA 2

CeFA 3

CeFA 4

IFS DIPLOMA

Do you have any Equity Release qualifications?

(If yes, please forward a copy of your relevant qualification certificate)

4

CII

JO1

JO2

JO3

JO4

JO5

JO6

JO7

JO8

CII DIPLOMA

Intrinsic Financial Planning Limited

Intrinsic Mortgage Planning Limited

Intrinsic Wealth Limited Positive Solutions(Financial Services) Limited

JO9

J1O

J11

J12

RO1

RO2

RO3

RO4

RO5

RO6

RO7

RO8

If yes, please confirm the life assurance company or network

Date your authorisation commenced

What is your current role, or job title andresponsibilities?

Current employment status

Employed

Unemployed

Self Employed

Education

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’)

If ‘No’, please tell us why

Resignation

Retirement

Termination / dismissal

End of contract

Redundancy

Yes No

Yes No

Yes No

Yes No

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

Nature of Business

Address of Firm

Town

County

Postcode

Telephone number

Fax Number

Email Address

Dates of employment/Self employment/Education

From Month

Year

Year

Current income £

Is the firm regulated by the FCA?

Are you or the firm an appointed representative?

Do you have the status of Competent Adviser?

5

To Month

Yes No

Resignation

Retirement


End of contract

Redundancy

Employed

Unemployed

Self Employed

Education

Yes No

Yes No

3.2 Work History

Fax Number

Email Address


From Month

Year

To Month

Year

Income £

Was this firm regulated by the FCA?

Were you or the firm an appointed representative?


What was your role, or job title and responsibilities?

Employment status

Can we contact this firm for a reference? (please note, a reference request will be issued immeditately if you tick ‘Yes’)


6

Reason for leaving

Name

Nature of Business

Address of Firm

Town

County

Postcode

Telephone number

7

Yes No

Resignation

Retirement


End of contract

Redundancy

Employed

Unemployed

Self Employed

Education

Yes No

Yes No

3.3 Work History

Fax Number

Email Address


From Month

Year

To Month

Year

Income £





Employment status



Reason for leaving

Name

Nature of Business

Address of Firm

Town

County

Postcode

Telephone number

Date

Date Company

Date

Date

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

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Company

Company

Company

Yes No

Resignation

Retirement


End of contract

Redundancy

Employed

Unemployed

Self Employed

Education

Yes No

Yes No

3.4 Work History

Fax Number

Email Address

Dates of employment/Self employment

From Month

Year

To Month

Year

Income £





Employment status



Reason for leaving

Name

Nature of Business

Address of Firm

Town

County

Postcode

Telephone number

Yes No

Yes No

Yes No

To

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)

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?

(Please provide further details under Additional Information at the back of the application)

Section 5 – Accountant Details

5.1 Accountant details

Title

Surname

Initials

How long has the above been your Accountant?

Address

Town

County

Postcode

Telephone Number

Fax Number

9

Email Address

From

Month Year

Trade Name:Company Name:

Trade address:

Trade email address:

Referee phone number:

Dates of your trading activites to be covered

Referee Name:

Referee address:


Dates of unemployment:

Referee email address:

Your relationship to referee:

Trade Name:Company Name:

Trade address:

Trade email address:


Dates of your trading activites to be covered

Referee Name:

Referee address:


Dates of unemployment:

Referee email address:

Your relationship to referee:

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.

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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.

Please note these Personal Referees cannot be family members or individuals with a relationship to Intrinsic.

Customer Date Nature of the complaint Outcome/Settlement Redress compensation amount

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

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?

b. Have you ever received any warnings, written or verbal?

c. Have you ever had an investigation or review carried out on you or the business conducted by you?

d. Have you ever undertaken or been asked to undertake any additional training, including increased supervision, under any Training and Competence Scheme?

e. Have you ever been assessed by the FCA or any authorised firm or regulatory body?

f. If you have been assessed please provide a copy of your assessment report? and RMAR (if applicable)?

g. Have you ever been removed from a Lenders panel or had an agency refused or terminated by a Product Provider?

h. Have you ever acted in a Directly Authorised capacity? N o

i. If yes, please provide a copy of your latest RMAR. Is this enclosed?

j. Have you ever had any remedial action in relation to treating customers fairly?

k. Have you ever been involved in the promotion, advice or selling of Arch Cru, Key Data or high risk products?

l. Have you ever had any complaints against you whether upheld or not? If yes please complete section 6.2 below.

m. Have you ever been the subject of a breach in relation to activities regulated by the Financial Conduct Authority.

n. Have you ever applied to the Intrinsic prior to this application?

6.2 Complaints Please provide full details regarding any complaints against you whether upheld or not.

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Yes No

Yes No

Yes No

Yes No

Name of Company/Individual Details of Business Relationship

Company Amount of Debt Details of Arrangements

to Repay the Debt

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

6.3 Other

a. Do you have any trading names?

If yes, please give full name(s)

b. Are you a shareholder in any other financial services company where your

shareholding exceeds 10% of total shares issued?

c. Have you ever held, or do you currently hold, any contracts with any

financial services company which are not listed in the employment section

of of the application?

d. Do 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.

e. Do you have any outstanding debts with any Financial Services Company? If yes, please enter full details below

6.4 Data Protection Licence (DPL)

Do you have a current DPL?

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.

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13

Section 7 – Fitness and ProprietyIf 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 ProceedingsWhen 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?

b Are you or have you ever been, the subject of any criminal proceedings, whether in the UK or elsewhere?

c Have you ever been given a caution in relation to any criminal offence?

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.)

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?

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

7.01.5 Has any firm at which you held a position of influence ever:

a Been convicted of any criminal offence?

b Been summonsed, charged with or otherwise investigated or prosecuted for any criminal offence?

c Been the subject of any criminal proceeding which has not resulted in a conviction?

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

Yes No

Yes No

Yes No

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7.02 Civil Proceedings

7.02.1 Have you ever been the subject of a judgement debt or award against you?

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 Any proceedings that have begun, or anyone’s intention to begin proceedings against you, for a CCJ or another judgement debt?

b More than one set of proceedings, or anyone’s intention to begin more than one set of proceedings, that may lead to a CCJ or other judgement debt?

c Anybody’s intention to claim more than £1,000 of CCJs or judgement debts in total from you?

7.02.4 Do you have any current judgment debts (including CCJs) made under a court order still outstanding, whether in full or in part?

7.02.5 Have 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?

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

7.02.6 Have you ever:

a Filed for your own bankruptcy or had a bankruptcy petition served on you?

b Been adjudged bankrupt?

c Been the subject of a bankruptcy restrictions order (including an interim bankruptcy restrictions order) or offered a bankruptcy restrictions undertaking?

d Made any arrangements with your creditors, for example a deed of arrangement or an individual voluntary arrangement (or in Scotland a trust deed)?

e Had assets sequestrated?

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?

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)?

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?

7.02.9 Are you currently:

a Party to any civil proceedings? (including those covered in 7.02.2 above)

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.)

7.02.10 Has any firm at which you hold or have held a position of influence ever been:

a Adjudged by a court civilly liable for any fraud, misfeasance, wrongful trading or other misconduct?

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.

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

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

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:

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?

Yes No

Yes No

Yes No

16

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)?

b The subject of any proceedings of a disciplinary nature (whether or not the proceedings resulted in any finding against you)?

c The subject of any investigation which has led or might lead to

disciplinary proceedings?

d Notified of any potential proceedings of a disciplinary nature against you?

e The 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.)

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?

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

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?

b Been 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?

d Been the subject of an investigation by any regulatory body, whether or not such an investigation resulted in a finding against you or the firm?

e Been 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)?

f Been investigated or been involved in an investigation by an inspector 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?

g Ceased operating or resigned whilst under investigation by any such body or been required to cease operating or resign by any regulatory body?

h Decided, after making an application for any licence, authorisation, registration, notification, membership or any permission granted by any such body, not to proceed with it?

i Been the subject of any civil action related to any regulated activity which has resulted in a finding by a court?

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?

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

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

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:

a Been found to have carried on activities for which authorisation or registration by the FCA/PRA or any other regulatory body is required without the requisite authorisations?

b Been 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?

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?

d Been investigated for the possible performance of a controlled 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?

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?

f Been the subject of disqualification direction under section 59 of the 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 Are 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?

7.05.2 Are you aware of any other information relevant to this application that we might reasonably expect from you?

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.

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

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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

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

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?

8.2 Do your liabilities exceed your assets?

8.3 Do you have any outstanding liabilities that are in arrears or subject to a specially agreed repayment schedule?

8.4 Have you ever had any property repossessed, made the subject of a repossession order, or voluntarily surrendered?

(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

£

8.7 Financial Status Questionnaire

Please provide details of all sources of income and liabilities (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

Total Net Monthly Income

Current monthly expenditure Lender

21

8.7 Financial Status Questionnaire

Please provide details of all sources of income and liabilities (including any business liabilities for which you are or may become liable) indicating whether they apply to you individually or jointly.

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

£

£

£

£

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. Costs relating to any other properties (including mortgage repayments)

h. Debt Management Plans

£

£

£

£

£

£

£

£

£

£

£

£

Lender Amount

Total Assets

Date due for payment

Yes

Yes

No

No

Assets

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

Liabilities

a. Mortgage

b. Mortgage Arrears (if applicable)

c. Loans

d. Bank overdraft

Is it authorised?

e. Credit cards

f. Personal Guarantees

g. Outstanding Financial Services debts

i. Buy to let/additional properties

j. Debt management plan

Amount

Purpose Lender Value

22

Total Liabilities

h. Income Tax

£ £

£

£

£

£

£

£

£

£

£

£

£ £

£

£

£

£

£

£

£

£

£

£

£

£

£

Additional Information

Please use this space to provide further details on information previously provided in this application

23

Post Code

Signature

From

To

Type of benefit claimed

1

2

3

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

Dear Sirs

Name

Address

Postcode

Insurance Number

Date of Birth

Dates claiming Month Year

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 To

Month Year Month Year Type of Benefit Claimed

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.

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Date

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

Proof of ID – Driving licence preferably, however passport is acceptable if accompanied with a utility bill dated

within the last 3 months

Certificates – Copies of all industry 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 3 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 – If currently unemployed

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 Up to date Experian/Credit report in current address, showing all previous addresses for last 3 years

2. CCJs – Must be settled or in a repayment plan Not applicable Evidence of up to date repayment plan OR Certificate of Satisfaction Signed statement detailing events, creditors, amounts and reasons for CCJs occurring Up to date Experian/Credit report in current address, showing all previous addresses for last 3 years

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 Up to date Experian/Credit report in current address, showing all previous addresses for last 3 years Signed statement detailing events, creditors, amounts and reasons for debt occurring

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 Up to date Experian/Credit report in current address, showing all previous addresses for last 3 years

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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 Up to date Experian/Credit report in current address, showing all previous addresses for last 3 years Formal list of creditors included with IVA/Trust Deed and amounts

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 Copy of Disclosure and Barring Service report

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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Please note - If you add an e-signature we will require a copy of the document with your actual signature on it.

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, Intrinsic Mortgage Planning Limited, Intrinsic Wealth Limited or Positive Solutions (Financial Services) 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.

– 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.

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.

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

Date

Name of your Intrinsic Regional Director

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