FCA Application

Application Contact Details

Associated Individual

Title

First Name

Last Name

Job Title

Email Address

Mobile

Phone Number

Address line 1

Address line 2

Address line 3

Postcode

Town

County

Country

Firm Details

Is the firm authorised by the FCA and/or PRA?

Firm Name

*Soletraders & Partnerships - Personal name. Trading name can be added later

Legal Status of the Firm

What type of firm is the applicant

For Soletraders* Year End DD/MM

Date of incorporation

Country of incorporation

Company Number

Firm Address Details

Principal Place of Business

Email Address

Mobile

Phone Number

Address line 1

Address line 2

Address line 3

Postcode

Town

County

Country

Website Details

Website address

Website launch date if not already launched

Firm Contact Details

Title

First Name

Last Name

Job Title

Email Address

Mobile

Tick if the contact person's address details are the same as the principal place of business

Details of Auditor/Reporting Accountant (If you have one appointed)

Title

First Name

Last Name

Job Title

Email Address

Mobile

Phone Number

Address line 1

Address line 2

Address line 3

Postcode

Town

County

Country

Details of Professional Adviser (if applicable)

Title

First Name

Last Name

Job Title

Email Address

Mobile

Phone Number

Address line 1

Address line 2

Address line 3

Postcode

Town

County

Country

Please tick this box if the Applicant wants us to copy all correspondence to the professional adviser

Please tick this box if the Applicant, if it becomes authorised/registered, plans to use a professional adviser

Locum Details

A temporary Personnel to cover illness etc only complete if applicable.

Title

First Name

Last Name

Firm Reference Number

Firm Name

Job Title

Email Address

Mobile

Phone Number

Address line 1

Address line 2

Address line 3

Postcode

Town

County

Country

Please tick this box if the Applicant wants us to copy all correspondence to the professional adviser

Please tick this box if the Applicant, if it becomes authorised/registered, plans to use a professional adviser

Trading Name

If the applicant intends to use any trading names as well as the registered name, provide details below

Which sales channels does the Applicant intend to use and what will each methodof sale be as a percentage of total sales

Sales Channel
Approximate % of total sales

Face to face

Telephone Sales

Internet Based Sales

Postal

Other

How will the Applicant source customers?
‍
Approximate % of total sales

Website Advertising

Other Advertising

Word of mouth

Third Parties

Lead Generator

Other

If the Applicant is leaving a network, provide details below
‍
Approximate % of total sales

Firm Reference Number of the network Firm

Date notice given (will be given)

Notice Period (Days)

All Business activities

Does the Applicant intend to carry on any unregulated business activities?

This refers to any activities the applicant will be carrying on which do not require authorisation by FCA,whether or not they are connected to the regulated activities the applicant will be carrying on.

Total Unregulated activities

Description of the unregulated business the Applicant will be conducting:

How will the applicant be remunerated?

Please give precise details regarding the applicant's remuneration structure, including both monies

If the Applicant intends to generate income from any other activities, please provide percentages (whereapplicable)

Fixed Fees

Percentage based fees

Commissions

Other

Additional Questions

Does the Applicant make any use of premium rate numbers?

If the Applicant will be undertaking any distance marketing as part of its regulated credit activities pleaseprovide full details (including how this carried out to comply with CONC 2.7 and 11.1):

Is the Applicant currently taking over the business of any other firm or are there any plans for theApplicant to do so? (Or if already

Will the Applicant be conducting any regulated credit business in the home of a customer (or aprospective customer)?

Scale of Business

How many clients does the Applicant expect to have in relation to its regulated activities?

At authorisation

12 months after authorisation

Branches

Will the Applicant have any branches in the UK that intend conducting regulated activities?

Outsourcing with third parties

What functions (if any) will the Applicant outsource? Outsourcing is the act of one firmcontracting with another to provide services that might otherwise be performed by in-houseemployees. You must include details of the parties that the functions will be outsourced to andhow the applicant firm will monitor and control the outsourced functions.

Limited Company

You must state the amounts of the different sources of the Applicant's capital

Fully paid-up ordinary shares

Share premium account

(Audited) reserves*

Revaluation services

Preference shares (allowable ifnot redeemable within two years)

(Verified) interim net profits*

Subordinated loans

Subordinated Loans

Does the Applicant have any subordinated loans?

Other funding

Does the Applicant have other external funding?

State the estimated peak debts under management inthe first 25 months after authorisation (in £)

Is the Applicant applying for the activity 'Operating an electronic system in relation to lending'?

Permissions Profiles

You should make sure that you choose the right permissions for your firm. View a list of all regulatedactivities, definitions and exemptions in the Perimeter Guidance Manual

Regulated Activity

Agreeing to carry on a regulated activity

Limitations

regulated activities specified in this

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