Call us on 01244 421 261

Let Alliance is proud to provide our products to both Directly Authorised and Appointed Representative intermediaries.

Once you have read and understood the notes relevant to you below, please complete the form at bottom of the page to register today for your Let Alliance agency.

This application should only be completed by firms who are directly authorised by the Financial Conduct Authority (FCA). If the firm is not showing as registered on the FCA register we will be unable to process this application.

Appointed Representative Firms

We deal with many Networks, most of which will arrange a Let Alliance agency on your behalf or upon your request. Please contact your network principal in the first instance to arrange a Let Alliance agency.

However if you are an Appointed Representative of any of the following networks, please click on the relevant network name below for the relevant notes and then complete the form at the bottom of the page.

This application should only be completed by firms who are directly authorised by the Financial Conduct Authority (FCA). If the firm is not showing as registered on the FCA register we will be unable to process this application.

This application should only be completed by AR firms who are authorised by the Financial Conduct Authority (FCA) with Intrinsic Independent Limited. If the firm is not showing as registered on the FCA register as an Appointed Representative of Intrinsic Independent Limited we will be unable to process this application.

This application should only be completed by AR firms who are authorised by the Financial Conduct Authority (FCA) with Financial Limited. If the firm is not showing as registered on the FCA register as an Appointed Representative of Financial Limited we will be unable to process this application.

This application should only be completed by AR firms who are authorised by the Financial Conduct Authority (FCA) with The On-Line Partnership Limited. If the firm is not showing as registered on the FCA register as an Appointed Representative of The On-Line Partnership Limited we will be unable to process this application.

This application should only be completed by AR firms who are authorised by the Financial Conduct Authority (FCA) with the Whitechurch Network Limited. If the firm is not showing as registered on the FCA register as an Appointed Representative of the Whitechurch Network Limited we will be unable to process this application.

All disclosure must be complete and unambiguous. After receiving the application and before confirming whether the application is acceptable, we may require you to provide additional information.

All information supplied on this form will be subject to verification and in some cases the application may be rejected dependant on information provided. Please advise us immediately in writing (or e-mail) of any changes to the information provided in this application before we confirm acceptance of the agency.

If you require any assistance in the completing this form, please contact us on 08458 873 830 and we would be more than happy to assist.

 

Your Company Details
















Registered Address (if different from above)










 Yes No

Firm Main Contact






Advisor Names & Job Titles

If your business has more than five advisors, please contact us on 01244 421167 after submitting this application

Advisor 1




Advisor 2




Advisor 3




Advisor 4




Advisor 5




Additional Information


 Yes No






 Yes No

Firm Bank Details

At Let Alliance we understand recurring income is extremely important to the growth of your business. With this in mind we pay Annual Indemnity commission, payable 12 months in advance in month one, followed by a further 12 months commission following each and every policy anniversary date.


 Yes No


 Yes No


 Yes No


 Yes No

Declaration

This form must be signed by an owner/director of the firm.

I declare that the information provided within this application form is complete and correct to the best of my knowledge and information. I confirm that there is no other relevant information of which Let Alliance should be aware.

If you are a Directly Authorised firm you will enter into an agreement with Let Alliance Limited as per the above Terms & Conditions. If you are an Appointed Representative of any of the below Networks, Let Alliance Limited has entered into an agreement with them allowing all Appointed Representative members to gain access to Let Alliance General Insurance products.

I am a:

 Directly Authorised Agency Intrinsic Independent Limited Financial Limited The On-Line Partnership Limited The Whitechurch Network Limited

Please enter your name below to sign the form:



 

Please allow up to 3 days for the establishment of any new agency at which point we will issue you with all the required Agency Codes.

© 2015 Let Alliance Ltd.