Stanhope Cooper Introducers – Become an Introducer

Are you an individual or a company?*

An individual

A company

Full legal name of proposed introducer*

Provide any trading name(s) applicable to this arrangement

Provide all previous trading names (if applicable)

Type of company*

Select the structure of your company

Specify your company type*

Company number / LLP number / UTR number*

Date company established / incorporated*

VAT number

Company registered address*

Address Line 1 Address Line 2 Town / City County Postcode Country

Company trading address (if different)

Address Line 1 Address Line 2 Town / City County Postcode Country

What is your company website URL?

Please ensure that you include http:// or https://.

Name*

Please enter the full legal name of the proposed introducer.

First Middle Last

Date of birth*

Email for proposed introducer*

Phone number*

Your UK passport number

Enter your UK passport number if you have one.

Your UK driving license number

Enter your UK driving license number if you have one.

Your bank & payment details

Your bank name

Your bank sortcode

Your bank account number

If applicable, please provide your accounts team email address

After investigation I/we confirm that the information given in this application is to the best of my knowledge, true complete and accurate.*

The Data Protection Act requires that we explain how your personal information will be used. The information you provide on this form will be used to assess your suitability as an Introducer. This could include seeking references for the purpose of verification, identification and, in accordance with our regulatory obligation, to assess whether you are fit and proper to perform the limited activities of an Introducer. We may share the information you provide with the FCA but will not share your information with anyone else or use it for any other purpose. You acknowledge and consent that the Company may carry out a search with a licensed Credit Reference Agency and may ask them to check all or any of the application details you have submitted. Should this application be successful, you agree to adhere to and be bound by the Company’s terms and conditions.

Yes

No

Your name*

Please enter the full name of the person completing this form.

First Last

Your position*

Please provide your job title or position in relation to the introducer.

Your email*

Please enter an email address we can use to communicate with you about your application.

Email address Confirm this email address

Signature*

Please add your signature before submitting.

Today's date*

Become an introducer

Your bank & payment details

Public and product liability insurance

Professional indemnity insurance

Third party liability insurance

Cyber insurance