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New Business Submission Form

Client Name

Adviser

Malcolm Coury Stephen Thornton David Underwood Richard Armstrong Ed Hockey Nick Penn Sarah Tremarco Denise Hope Nick Twist Ross Pepperell Phil Simmonds Ty Smith Lindsay Smith Richard Waters Ian Paterson Steve Murphy

Provider/Lender

Date

New business?

Yes Top-up Transfer of agency Re-registration to WRAP Protected Rights

Client type

PersonalCorporateTrustStaffSupplierSSASGroup scheme

Client classification

Private customerIntermediate customerMarket counterparty

Client since (date)

Advice given

Full adviceLimited adviceExecution OnlyRestricted adviceDirect offerContrary to adviceOther

Conducted by?

Face to face meetingTelephoneEmailCorrespondenceOther

Source of business

Sales visitRepeat customerTelephoneCold callingDirect offerInternet saleMarketing listPostal sale Referral from intermediary Referral from non-authorised introducer Insistent client Other

Introducer name

No introducerAlison de VilleBath RugbyCity Central David Earle Brown Graham Start Gwen Giddings Home Choice Letting Agency Knights Michael Assad Mark Stylianov Neil Jordan R.S. Property Solutions Rashpal Bancil & Sukhjinder Bains Reid Financial Services Sue Gidney Weir Estates Wilson Gale Other

Best advice?

Best adviceNon-Best advice

Product Recommended

Annuity - CPA - PLA - DeferredAccident / Sickness / Unemployment coverBond- Distribution, Investment, With Profit, PortfolioBuildings / Contents insuranceContribution InsuranceCritical Illness,Terminal IllnessDraw Down / Pension fund withdrawalPrivate Medical Insurance Endowment Family Income Benefit Group Pension Plan Group PHI Group Life ISA - Maxi, Mini, TESSA MIP Mortgage (Lifetime) Mortgage (Not Lifetime) Pension - Executive Pension - FSAVC Pension - Personal Pension - Protected Rights Pension - Section 32 Pension - SIPP Pension - SSAS Pension - Stakeholder Pension - Stakeholder (Infant) PEP transfer PHI Term - with CIC - Convertible Term - with CIC - Decreasing Term - with CIC - Increasing Term - with CIC - Key person Term - with CIC - Level Term - with CIC - Pension Term - with CIC - Renewable Term - with CIC - Shareholder protection Term - without CIC - Convertible Term - without CIC - Decreasing Term - without CIC - Increasing Term - without CIC - Key person Term - without CIC - Level Term - without CIC - Pension Term - without CIC - Renewable Term - without CIC - Shareholder protection Trustee Investment Plan Unit Trust OEIC ICVC Whole Life

Have you sold such a product in the last 6 months?

YesNo

Will premiums be paid in retirement?

NoYes, and proof of affordability after retirement is on fileYes, but proof of affordability after retirement is not on file

Is this replacing an existing plan?

NoSurrenderTransferReplace Lapsed Made 'paid up' Cancelled

Opt-out of OPS*

NoYes

*i.e. Is the client transacting a Pension opt-out, or leaving or declining to join an occupational pension scheme in favour of a SIPP, stakeholder or personal pension scheme?

If yes to any of the above please give details.

 

Mortgage Payment Protection Insurance (MPPI / ASU)?

N/A, mortgage not soldYes, by adviserNo, client bought elsewhere No, client declined, disclaimer to follow No, client declined and signed disclaimer No, client declined and did not sign disclaimer

Initial incentive type?

N/A, mortgage not sold Capital Repayment mortgage Interest Only mortgage, with a repayment vehicle Interest Only mortgage, without a repayment vehicle Other

Repayment type?

N/A, mortgage not sold Fixed rate Discount rate Tracker Flexible Other

Mortgage loan purpose?

N/A, mortgage not sold Purchase Remortgage Unsecured loan Second charge Further advance Other

Mortgage property type?

N/A, mortgage not sold Residential Commercial Buy to Let Other

Mortgage loan type?

N/A, mortgage not sold First time buyer Home mover Second home Property improvements Debt consolidation Capital raising Pound for pound transfer Equity release Other

Mortgage reference status?

N/A, mortgage not sold Full status Non status Self cert Other

Mortgage case status?

N/A, mortgage not sold Standard Adverse Other

Mortgage club

Documentation entered on to 1st: 

Application Form

YesNoNot applicableTo follow

Application Online or paper?

Not applicableOnlinePaper

Cheque or DD

YesNoNot applicableTo follow

Terms of Business (date sent)

IDD / Key Facts (date issued)

Menu (date issued)

Client / Fee agreement (date sent)

Fact find (date first completed)

By

Malcolm Coury Stephen Thornton David Underwood Richard Armstrong Ed Hockey Nick Penn Sarah Tremarco Denise Hope Nick Twist Ross Pepperell Phil Simmonds Ty Smith Lindsay Smith Richard Waters Ian Paterson Steve Murphy

Fact find (date last updated)

By

Malcolm Coury Stephen Thornton David Underwood Richard Armstrong Ed Hockey Nick Penn Sarah Tremarco Denise Hope Nick Twist Ross Pepperell Phil Simmonds Ty Smith Lindsay Smith Richard Waters Ian Paterson Steve Murphy

Money Laundering form

YesNoNot applicableTo followOn file recently

Evidence of research

YesNoNot applicableTo follow

KFI

YesNoNot applicableTo follow

Commission Disclosure

YesNoNot applicableTo follow

Suitability Letter (Introduction paragraphs)

YesNoNot applicableTo follow

Suitability Letter (Appendix / Main recommendation)

YesNoNot applicableTo follow

Client confirmation page

YesNoNot applicableTo follow

Premium(s)/Contribution(s)

Mortgage amount £

Property Valuation / Purchase Price £

Frequency

Lump sumMonthlyLump sum and MonthlyQuarterlyAnnually

Commission at outset (type)

Indemnity (Protection Business - all up front) Non-indemnity (Protection Business - on the drip) Single Premium (Investment or Pension business) Mortgage Proc Fee

Commission at outset (amount) £

Commission ongoing (type)

Renewal (Protection Business)(Premium based) Trail (Investment or Pension business)(Value based) Mortgage Proc Fee

Commission ongoing (amount)

£

Proc Fee £

Client Fee £