Acasta API | Acasta Europe Limited - Broker Agency Application Form

Acasta Europe Limited - Broker Agency Application Form

Please fill in following details.

If you have already applied in the past please contact us 0800 223 0385 to restart your application.

INTERMEDIARY APPLICANT DETAILS

Firm Name

Trading Name

FCA Status

FCA Registration Number

Principal Name

Company Registration Number

Address

Please search and select an address.

Company Address Line 1

Company Address Line 2

Company Town/City

Company Postcode

Company Country

Company Website

e.g. http://www.example.co.uk

CONTACT DETAILS

Contact First Name

Contact Surname

Contact Position

Contact Telephone

Contact Email

PROFESSIONAL INDEMNITY INSURANCE DETAILS

Indemnity Insurer

Indemnity Renewal Date

Indemnity Limit

Current Premium

FINANCIAL CRIME POLICIES

To the best of your knowledge and belief have you or any director, shareholder, partner or employee of the firm ever been:

Convicted of any criminal offence (save minor motoring) or is any offence pending

Subject to disciplinary proceedings by any regulatory body or is any offence pending

Subject to a professional negligence claim or notification that such a claim is pending

Refused Professional Indemnity Insurance

Involved in liquidations, receiverships or bankruptcy

Received an administration order or entered into any administration agreement

Entered into any agreement with creditors that has been approved by court

Disqualified under Company Legislation

Found for negligence, fraud, misfeasance or wrongful trading

Had any insurance scheme terminated early or renewal terms declined to be offered

Have any legal or regulatory reason why you are unable or not fit to carry out the duties involved with the provision of insurance

If you answered Yes to any of the above please provide full details

All disclosure docs issued are in accordance with the regulations imposed in the IDD.

All sub-brokers/retailers/distributers and anyone to who undertakes sales/administration of any kind is fully and properly registered to perform the actions they are undertaking.

The company has in place a compliant and up to date data protection policy and procedures in place including all changes brought in new GDPR regulations.

Does your company have a compliant and up to date anti-money laundering, anti-bribery and corruption and financial sanction policy

Do all staff receive the relevant training and CPD as required under the provisions of the Insurance Distribution Directive ?

By submitting this application you are confirming that all information provided above is true and accurate to the best of your knowledge, and that any information gained from outside of the scope of your knowledge has been confirmed with the relevant parties.