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Please scroll down to complete our Introducer Appointed Representative (IAR) Application Form


Your Details

Your Business Details

(please give us as much information as possible)

(if different from above)
If different from trading address
If applicable

Your Legal Status

Type of business *

Compliance details

(if available please provide)

History of the Applicant Firm

Is the applicant Firm currently regulated by the Financial Conduct Authority (FCA) for any activities, either directly or as an Appointed Representative of another firm? *
Has the applicant Firm ever been refused, or had revoked, any license, membership, authorisation, registration, or other permission granted by a financial services regulator or government body in the UK or overseas? *
Has the applicant Firm ever having made an application to a regulatory body for a licence, authorisation, registration, membership, or permission granted by a regulatory body, decided not to proceed with it? *
Is your company registered with the Information Commissioners Office (ICO)? *

Disclosure of Significant Events

Has the Firm ever been presented with a petition for bankruptcy, a petition for compulsory winding up or Creditor’s voluntary arrangements? *
Has the Firm ever had a Receiver or Administrator appointed, failed to satisfy a debt adjudged due, or come to a compromise or similar arrangement over a debt with any of its creditors? *
Has the Firm ever been the subject of a corporate restructure, because of any form of insolvency or otherwise? *
Has the Firm ever been the subject of any criminal investigations or proceedings? *
Has the Firm been the subject of any civil investigations or proceedings or arbitration in the last five years? *
Does the Firm have any unsatisfied judgements, debts or awards outstanding against it? *
Has the Firm entered into any material settlements in the last five years, whether or not on an ex-gratia basis? *
Has the Firm ever been convicted of fraud or other dishonesty? *
Has the Firm ever been convicted of an offence under legislation (whether in the UK or not)? *
Has the Firm had any material complaints made against it by its clients or former clients in the last five years which it has accepted, or which are awaiting determination, or have been upheld, by an ombudsman or a complaints scheme? *
Has the Firm ever been: criticised, publicly censured, investigated, disciplined, suspended, expelled, fined, or been subject to any other disciplinary intervention action, by any financial services regulator, clearing house, exchange, professional body or government body or agency in the UK or abroad? *
Has the Firm ever been found guilty of carrying on any unauthorised regulated activities or been investigated for the possible carrying on of unauthorised regulated activities? *
Is the Firm currently involved in any proceedings, investigations or other events referred to in any of the questions above that are pending or not yet determined? *
Are there any other significant events relating to the Firm which we have not asked about in the above questions that have happened, or are taking place, that are relevant to the Firm’s application for authorisation? *

Other Information

Are you a member of a trade association?
(please specify)

Terms & Conditions

Yes

Yes

IAR Agreement

Privacy policy and terms & conditions.

For the purposes of complying with the Data Protection Act, the personal information provided in this form may be shown to the Financial Conduct Authority if required by them to do so and shown on the FCA public register. The information will not be disclosed for any other purpose without the permission of the applicant firm.

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© Citybond Suretravel 2022

*Calculated against Gross Written Premium

Citybond Suretravel is a trading name of Travel Insurance Facilities Plc which is authorised and regulated by the Financial Conduct Authority, FRN 306537.
Company registered in England and Wales No. 03220410, Registered Office: 1 Tower View, Kings Hill, West Malling, Kent, ME19 4UY. All rights reserved. All policies offered are on a non-advised basis.