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Tenant Assessments

Intrinsic Independent Ltd

Application Form for Appointed Representatives of Intrinsic Independent Limited

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.

Company Details

Company Name (as shown on FCA register) *

Company Address & Postcode (as shown on FCA register)

Office Telephone Number *

Fax Number

Office E-mail *

Company Type *

If Other please specify:

FCA Firm Number *

Date FCA Number Issued

Companies House Number (if applicable)

Business Type *

Registered Address (if different from above)

Number of Advisers *

Number of Branches *

If your firm has multiple branches, would you like individual agencies per branch?

If yes, please provide branch address and contact details:

Firm Main Contact

Name *

Job Position *

Telephone Number *

Email Address *

Adviser Names & Job Titles

If your business has more than five advisers, please contact us on 01244 421 167 after submitting this application

Additional Information

Do you have Professional Indemnity Insurance? *

Professional Indemnity Insurance Provider Name

Amount of Cover (£)

Renewal Date

How many Buy to Let mortgage clients do you have (approx.)?

How many Landlord/Tenant Insurance sales do you do per annum (approx.)?

Commission

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 to Intrinsic Independent Limited, payable 12 months in advance in month one, followed by a further 12 months commission following each and every policy anniversary date.

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.

Let Alliance Limited has entered into an agreement with Intrinsic Independent Limited allowing all Appointed Representative members to gain access to Let Alliance General Insurance products.

Data Protection Notice

The information on this application form may be “personal data” as defined in the Data Protection Act 1998 (DPA). The personal information provided in this form will be used by one or more members of the Let Alliance Limited and/or our alliance partners. We may obtain further information about you or your firm from credit reference agencies, the Financial Conduct Authority (FCA) and/or other regulatory bodies that may also be personal data.

We will use this information to decide whether to enter into the agreement with the firm. We may further use the information we hold to decide periodically whether to continue with the agreement. We may use the information to administer our agreement with you. We may share all information we have about you with insurance companies, credit reference agencies, debt recovery companies, tracing services, the FCA and/or other regulatory bodies in order to protect our and others' interests, and to prevent fraud. We may use information that is not sensitive personal data as defined by the DPA for marketing purposes, and may share this information within Let Alliance Limited or with our marketing or alliance partners. When you provide us with this information you are consenting to our use of it as set out in this notice. If you have questions about our use of personal information, or if you believe our records are inaccurate, you should write to the Data Protection Officer, Let Alliance Limited, 1st Floor Dodleston House, Bell Meadow Business Park, Park Lane, Pulford, Chester, CH4 9EP.

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