Online Application Form

To apply for your general insurance agency, please complete the form below.

Your data is protected by secure SSL encryption.

Intermediary Application

General Insurance

Click here to view our Terms Of Business Agreement – VERSION – 3rd May 2018.

Before submitting your application, you must read and agree to our Terms of Business Agreement.

Please print a copy for your records.

This form must only be completed by those firms who are directly authorised by the Financial Conduct Authority (FCA).

The person completing the form must be a Director (Limited Companies) or Principal / Partner and defined and registered as such on the FCA register. We will email confirmation of your agency number to the email address on the FCA register (or by post if there is no email address) once your application for a general insurance agency has been formally approved.

* Required

1. Agency Details

Important: This application form is only for use by directly authorised sole-traders.

Please provide your Information Commissioner registration number:

Yes No

Appointed Representative has the meaning given to it in section 39(2) of the FSMA (including any person making sales or representations on behalf of any Appointed Representative).

If yes, please contact us at ifasupport.gi@landg.com for additional information prior to completing this application form.

FRN (Firm Registration number with the FCA)

Company name in which the agency is requested

If you have a Life Agency Number, please provide

Please be aware that any of the following permissions granted by the FCA, must relate to non-investment insurance contracts and apply to retail customers:

Arranging (bringing about) deals in investments.
Making arrangements with a view to transactions in investments.
Dealing in investments as an agent.
Advising on investments (except on Pension Transfers and Pension Opt Outs).You can check your firm’s current permissions profile by visiting www.fca.org.uk/register/

It is also an important requirement that the firm has the ability to conduct General Insurance mediation activity.

Is the firm registered for the purposes of the Consumer Credit Act with the FCA?

Yes No

If yes, what credit permissions do you hold (e.g. credit broking, debt counselling.)

Please provide a general description of the firm’s business trading model:-

Are policies sold on an advised basis?

Yes No

Are policies sold via the telephone?

Yes No

Does the firm introduce business to another firm?

Yes No

Does the firm handle claims on behalf of customers?

Yes No

2. Contact Details

Full registered business address

Line 1

Line 2

Line 3

Line 4

Postcode

Preferred contact number

Email address

3. Data Protection

Is the firm registered with the Information Commissioner?

Yes No

Please provide your Information Commissioner registration number:

Please note that the following categories are required:

Accounts & Records
Insurance Administration
Provision of Financial Services and Advice

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