LetSafe We Are A Company Who Pride Ourselves On A First Class Service

Agent Details

General

full company name

address

telephone

fax

town

postcode

website address

contact name

main type of business

Business Profile

how many staff in your business are involved in general insurance activites?

Please indicate which one of the following best describes your future plans under the proposed FSA regime by ticking the appropriate box. Using the chart below, look at which products or services you would like to use. This will tell you how you should be authorised.

Ie; If you wish to use Tenant Assessment and Rent Guarantee & Legal Protection you should tick the box marked Authorised Representative.

	Tenant Assessment	Rent Guarantee & Legal Protection	Buildings Insurance	Contents Insurance
Non-Regulated Introducer	P
Authorised Representative	P	P	P	P
Principal	P	P	P	P

I wish to be an Authorised Introducer Only (NR)

I wish to be an Authorised Representative (AR)

I will be registering my company with the FSA as a Principal
(Fully Authorised Member within the FSA)

What LetSafe Products / Services would you like to use?

tenant assessment

rent guarantee & legal protection

buildings insurance

contents insurance

Please note: There is a one off registration payment fee of £50 + VAT which covers all administration costs, your welcome pack and Anti Money Laundering checks. AML checks were introduced in December 2007 and are now a legal requirement which we must process on every customer/agent that opens an agency. By submitting this application form to LetSafe, you agree to pay the registration fee and you allow LetSafe to carry out necessary checks under the Anti Money Laundering Scheme.

I AGREE

send this application to join