Application Form Investment Adviser CF30

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1 Application Form Investment Adviser CF30 Applicants Name The purpose of this document is to assist us in processing your application efficiently. This application should be fully completed and returned by Recorded Delivery to us at the address shown in the covering letter. Please complete in BLACK INK. Please complete all sections, do not leave blanks. Please ensure that the following original documents (where possible) accompany your fully completed application to join. All original certificates and statements will be returned to you. Required documents: Please tick if enclosed Curriculum Vitae (CV) Qualification Certificates : Diploma in Regulated Financial Planning, FPC (or equivalent) Evidence of current Competent Adviser Status Current / Previous SPS Certificate Key Performance Indicators Report from previous role Evidence of Assets and Liabilities Adverse Financial History Correspondence, if appropriate Disciplinary History Correspondence, if appropriate Evidence of identity/address Certified copies of Passport and/or Driving Licence Certified copies of last 3 months bank statements Certified copies of last 3 months payslips / previous sets of Accounts Certified copy of P60 Certificate of Incorporation and registered address Fit and Proper declaration Other (please detail) 1

2 Please complete all of the following information as fully as possible. 1. Personal Information Full Names(s) First Middle Surname Title (Please circle) Mr / Mrs / Miss / Ms / Other: Contact details Day Eve Mobile Date of Birth Mothers Maiden Name Current Address Place of Birth Country of Birth Have you ever used any other names including maiden name or name changed by deed poll? If so, please provide first name and last name and date this was used until Date moved in Postcode If the above address covers a period of less than 5 years then please provide further details below Previous address Date moved in Date moved out Postcode Previous address Date moved in Date moved out Postcode National Insurance No Passport No 2

3 Firm details Current/previous FSA/FCA individual No: Appointed Rep Firm name / Registered Individual name Limited Company / LLP Sole Trader (delete as applicable) Companies House details Registration No: Registration date: Companies House registered address (please state if own or accountants address) Firm/Company Address The FCA state that the address shown on the FS Register should be the firms principle place of business Appointed Rep Firm/Registered Individual trading names If the applicant intends to use any trading names as well as the registered name, provide details Employment history over the last 5 years including gaps Date joined Employer name & Address Position / duties Date left Reason Employment history over the last 5 years including gaps Date joined Employer name & Address Position / duties Date left Reason 3

4 Employment history over the last 5 years including gaps Date joined Employer name & Address Position / duties Date left Reason Other notes on gaps between employment i.e. unemployed periods 2. References Former employment contact(s) who we can approach for a reference: Name / Address / and telephone number Other professional contact whom we can approach for a reference: Name / Address / and telephone number 3. Qualifications Date attained Type 4. Training & Competence Current status Date assessed as competent Do you have a current Statement of Professional Competent adviser / Trainee adviser (delete as appropriate) Yes / No 4

5 standing? SPS issued by Date of issue Any other relevant information relating to previous competence Are you qualified for any specialist areas? Detail protection / insurance products advised on in the last 3 years Detail pension products advised on in the last 3 years Pension Transfers / Long Term Care / None (delete as appropriate) Term / Whole of life / Income Protection / Long term care / PPI Other: PPP / SHP / SIPP / Income Drawdown / Pension switches Other: Detail savings and investment products advised on in the last 3 years Detail mortgage products advised on in the last 3 years Detail any high risk areas not mentioned above you have advised on in the last 3 years Gross commission /fee levels achieved in the last 3 years Unit Trust / Investment Trust / OEIC / Investment Bonds / ISA / VCT / EIS / Endowments / Structured Products / UCIS / UCITS / National savings Other: Repayment / Interest only / Buy to let / Let to Buy / Commercial / Equity release / Lifetime Mortgage Other: 5. Other Business Interests Detail name and nature of business interest 6. Financial Position Assets Principle Residence Other Property Bank / Building Society National Savings Unit / Investment Trusts Liabilities Mortgage Loans Hire Purchase Credit Cards Potential Tax Liability 5

6 Investment Bonds ISAs VCTs / EISs Stocks / Shares Pensions Others please detail Others please detail Total Assets Total Liabilities As part of the FCA fit and proper requirements we must establish the financial position of all applicants. Please indicate where assets/liabilities are held jointly. Have you ever been subject to a CCJ/VA or bankruptcy? Additional notes Yes / No 7. Complaints Have you had a complaint against you? If yes what was the outcome? 8. Previous disciplinary matters / Criminal records Have you ever been the subject of a disciplinary matter or investigation? If yes please given details Did you resign or were you dismissed from any previous appointment for any reason connected with a breach or alleged breach of the Regulators rules or conviction, fraud, dishonesty or violence? 6

7 If yes please give details Do you have any unspent convictions? 9. Any other information Please provide any further information in support of your application here on further documentation 10. Fitness and Propriety Declaration The following questions have been lifted from the FCA Form A application which will be completed by Vision as part of the authorisation process should your application proceed further. FCA Disclosure Note: We require firms to disclose all relevant information relating to a candidate s fitness and propriety. If there is any doubt about the relevance of the information, the information should be disclosed. The FCA takes non-disclosure very seriously and may consider it to be evidence of dishonesty and/or lack of integrity. In all circumstances, disclosures should be full, frank and unambiguous; if in doubt, disclose. In the event that a candidate discloses adverse information to the Applicant (or the Applicant knows of adverse information by some other means) the Applicant has a duty to disclose that information candidly to the FCA and explain why the Applicant considers this does not affect the candidate s fitness and propriety. 1.1 Criminal Proceedings When answering the questions in this section you should include matters whether in the UK or overseas. By virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975, if you are subject to the law of England and Wales, you must disclose spent convictions and cautions (other than a protected conviction or caution). (In the following questions, you should include all matters even when the arrest, charge, prosecution or investigation did not result in a conviction, and, in respect of 1.1.4, even where you yourself were not the subject of the investigation.) a) Have you ever been convicted of any criminal offence (whether spent or not and whether or not in the United Kingdom): Involving fraud, theft, false accounting, offences, against the administration of public justice (such as perjury, perverting the course of justice and intimidating of witnesses or jurors), serious tax offences or other dishonesty, or Relating to companies, building societies, industrial and provident societies, credit 7

8 unions, friendly societies, insurance, banking or other financial services, insolvency, consumer credit or consumer protection, money laundering, market manipulations or insider dealing? b) Are you currently, or have you ever been, the subject of any criminal proceeding, whether in the UK or elsewhere? c) Have you ever been given a caution in relation to any criminal offence? Have you had any convictions for any offences other than those in above (excluding traffic offences that did not result in a ban from driving or did not involve driving without insurance)? Have you ever been arrested or charged with any criminal offence or been the subject of any criminal investigation? (You should include all matters even if the arrest, charge or investigation did not result in a conviction) Have you ever been ordered to produce documents pursuant to any criminal investigation or been the subject of a search (with or without a warrant) pursuant to any criminal investigation? Has any firm at which you hold or have held a position of influence ever: a) Been convicted of any criminal offence? b) Been summonsed, charged with or otherwise investigated or prosecuted for any criminal offence? c) Been the subject of any criminal proceeding which has not resulted in a conviction? d) Been ordered to produce documents in relation to any criminal investigation or been the subject of a search (with or without a warrant) in a relation to any criminal investigation? 1.2 Civil Proceedings Have you ever been the subject of a judgement debt or award against you? Have you ever been party to any civil proceedings which resulted in any order against you (other than a judgement debt or award referred to at above)? (You should include, for example, injunctions and employment tribunal proceedings) Are you aware of: a) Any proceedings that have begun, or anyone's intention to begin proceedings against you, for a CCJ or another judgment debt? b) More than one set of proceedings, or anyone's intention to begin more than one set of proceedings, that may lead to a CCJ or other judgment debt? c) Anybody's intention to claim more than 1,000 of CCJs or judgment debts in total from you? Do you have any current judgment debts (including CCJs) made under a court order still outstanding, whether in full or in part? Have you ever failed to satisfy any judgment debts (including CCJs) made under 8

9 a court order still outstanding, whether in full or part, within one year of the order being made? Have you ever: a) Filed for your own bankruptcy or had a bankruptcy petition served on you? b) Been adjudged bankrupt? c) Been the subject of a bankruptcy restrictions order (including an interim bankruptcy restrictions order) or offered a bankruptcy restrictions undertaking? d) Made any arrangements with your creditors, for example a deed of arrangement or an individual voluntary arrangement (or in Scotland a trust deed)? e) Had assets sequestrated? f) Been involved in any proceedings relating to the above matters even if such proceedings did not result in the making of any kind of order against you or result in any kind of agreement with you? Do you, or any undertaking under your management, have any outstanding financial obligations arising from regulated activities, which have been carried out in the past (whether or not in the UK or overseas)? Have you ever been adjudged by a court or tribunal (whether criminal, civil or administrative) for any fraud, misfeasance, negligence, wrongful trading or other misconduct? Are you currently: a) Party to any civil proceedings? (Including those covered in 1.2.7) b) Aware of anybody's intention to begin civil proceedings against you? (You should include any ongoing disputes whether or not such dispute is likely to result in any order against you) Has any firm at which you hold or have held a position of influence ever been: a) Adjudged by a court civilly liable for any fraud, misfeasance, wrongful trading or other misconduct? b) The subject of a judgment debt or award against the firm? (You should include all CCJs) made against the firm, whether satisfied or not? c) Party to any other civil proceedings which resulted in an order against the firm other than in relation to matters covered in a) and b) above? Is any firm at which you currently hold, or have held within the last 12 months from the date of submission of this form, a position of influence: a) A party to civil proceedings? b) Aware of anyone's intention to begin civil proceedings against them? Has any company, partnership, or unincorporated association of which you are 9

10 or have been a controller, director, senior manager, partner or company secretary, in the United Kingdom or elsewhere, at any time during your involvement, or within one year of such an involvement, been put into liquidation, wound up, ceased trading, had a receiver or administrator appointed or entered into any voluntary arrangement with its creditors? 1.3 Business and Employment Matters Have you ever been: a) Disqualified from acting as a director or similar position? (One where the candidate acts in a management capacity or conducts the affairs of any company, partnership or unincorporated association). b) The subject of any proceedings of a disciplinary nature (whether or not the proceedings resulted in any finding against you)? c) The subject of any investigation which has led or might lead to disciplinary proceedings? d) Notified of any potential proceedings of a disciplinary nature against you? e) The subject of an investigation into allegations of misconduct or malpractice in connection with any business activity? This question covers internal investigation by an authorised firm, as well as investigation by a regulatory body, at any time Have you ever been refused entry to, or been dismissed, suspended or requested to resign from, any professional, vocation, office or employment or from any fiduciary office or position of trust whether or not remunerated? Do you have any material written complaints made against you by your clients or former clients in the last five years which you have accepted, or which are awaiting determination, or have been upheld - by an ombudsman or complaints scheme? 1.4 Regulatory Matters In relation to activities regulated by the FCA and/or PRA or any other regulatory body has: The candidate, or Any company, partnership or unincorporated associate of which the candidate is or has been a controller, director, senior manager, partner or company secretary, during the candidate's association with the entity and for a period of three years after the candidate ceased to be associated with it, ever a) Been refused, had revoked, restricted, been suspended from or terminated, any licence, authorisation, registration, notification, membership or any other permission granted by any such body? b) Been criticised, censured, disciplined, suspended, expelled, fined, or been the subject of any other disciplinary or interventional action by any such body? c) Received a warning (whether public or private) that such disciplinary or interventional action may be taken against you or the firm? d) Been the subject of an investigation by any regulatory body, whether or not such an investigation resulted in a finding against you or the firm? e) Been required or requested to produce documents or any other information to any 10

11 regulatory body in connection with such an investigation (whether against the firm or otherwise)? f) Been investigated or been involved in an investigation by an inspector appointed under companies or any other legislation, or required to produce documents to the secretary of state, or any other authority, under any such legislation? g) Ceased operating or resigned whilst under investigation by any such body or been required to cease operating or resign by any regulatory body? h) Decided, after making an application for any licence, authorisation, registration, notification, membership or any permission granted by any such body, not to proceed with it? i) Been the subject of any civil action relation to any regulated activity which has resulted in a finding by a court? j) Provided payment services or distributed or redeemed e-money on behalf of a regulated firm or itself under any contractual agreement where that agreement was terminated by the regulated firm? k) Been convicted of any criminal offence, censured, disciplined, or publicly criticised, by any inquiry, by the Takeover Panel or any governmental or statutory authority or any other regulatory body (other than as indicated in this group of questions)? In relation to activities regulated by the FCA/PRA or any other regulatory body, have you or any firm at which you hold or have held a position of influence at any time during and within one year of your association with the firm ever: a) Been found to have carried on activities for which authorisation or registration by the FCA/PRA or any other regulatory body is required without the requisite authorisation? b) Been investigated for the possible carrying on of activities requiring authorisation or registration by the FCA/PRA or any other regulatory body without the requisite authorisation whether or not such investigation resulted in a finding against you? c) Been found to have performed a controlled function (or an equivalent function requiring approval by the FCA/PRA or any other regulatory body) without the requisite approval? d) Been investigated for the possible performance of a controlled function (or an equivalent function requiring approval by the FCA/PRA or any other regulatory body) without the requisite approval, whether or not such investigation resulted in a finding against you? e) Been found to have failed to comply with an obligation under the Electronic Money Regulations 2011 or Payment Services Regulations 2009 to notify the FCA/PRA of the identity of a person acting in a position of influence over its electronic money or payment services business? f) Been the subject of disqualification direction under section 59 of the Financial Services Act 1986 or a prohibition order under section 56 FSMA, or received a warning notice proposing that such a direction or order be made, or received a private warning? 1.5 Other Matters Are you, in the role to which the application relates, aware of any business interests, employment obligations, or any other circumstance which may conflict with the performance of the controlled functions for which approval is now being sought/ in 11

12 the respect of your control of the firm / with your role as controller of the applicant firm or your position at the controller? Are you aware of any other information relevant to this notification that we might reasonably expect you to give? If you have answered Yes to any of the above questions please provide further notes to these questions here or on a separate sheet: Is there any other information you consider to be relevant to the application? If Yes please provide details: Do you currently hold any directorships? If Yes please provide details: Have you previously held directorships in the past 10 years? If Yes please provide details: Other notes in relation to the above questions: 12

13 11. Declaration Knowingly or recklessly giving information to Vision which is false or misleading in a material particular may be a criminal offence (section 398 of the Financial Services and Markets Act 2000). It should not be assumed that information is known to Vision merely because it is in the public domain or has previously been disclosed to Vision. If there is any doubt about the relevance of information, it should be included. For the purposes of complying with the Data Protection Act, the personal information provided in this Form will be used by Vision to for the purposes of recruitment only and will not be disclosed for any other purpose without the permission of the applicant. With reference to the above, Vision may seek to verify the information given in this Form including answers pertaining to fitness and propriety. In signing the form below: a) I authorise Vision to make such enquiries and seek such further information as it thinks appropriate in the course of verifying the information given in this Form or in assessing fitness and properness. This may include a credit reference check b) Vision will apply for to the Criminal Records Bureau for a search to be made as to whether any criminal records are held in relation to them and to disclose the result of that search to Vision. I also understand that the results of these checks may be disclosed to the FCA or other relevant body if required to do so. c) I confirm that the information in this Form is accurate and complete to the best of my knowledge and belief. d) I confirm that I understand the regulatory responsibilities of my proposed role as set out in the Statements of Principle and Code of Practice for Approved Persons Full Name Signature 13

14 Date 14

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