New Broker Application Form
Company Details
Broker Name:
*
Company Type:
*
Please Select
Sole Trader
Limited Company
Other
Company number:
*
Number of Directors:
*
Years of Trading:
*
Managing Director's Full Name:
*
First Name
Last Name
Managing Directors Home Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Main Office Phone Number:
*
Format: (0000) 000-0000.
Main Office Landline:
*
Format: (0000) 000-0000.
Main Email Address:
*
example@example.com
Office Trading Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Website:
*
Company Structure
How many sales staff do you have?
*
How many admin staff do you have?
*
How many compliance staff do you have?
*
Are all staff employed?
*
Please Select
Yes
No
If no, please provide more information here:
*
Company Experience
Please provide a breakdown of relevant experience:
*
Who is your current aggregator(s)? (Or previous if no longer partnered)
*
Please detail positives and negatives of aggregator partnerships:
*
Please advise reason for partnership request with UCR Consultants:
*
Sales
Current/targeted sales per week:
*
Current/targeted live rate:
*
Percentage of written LOAs
*
Percentage of verbal LOAs
*
Percentage of SME customers
*
Percentage of Corporate customers
*
Expected commission split:
*
Please detail here your sales method: (please include if any field/overseas activity/lead purchase source/specialised customer industries)
*
All outbound telesales number:
*
Format: (0000) 000-0000.
Please provide details of any additional service you offer to customers: For example, bill validation
Suppliers
Please list any direct supplier relationships you currently have:
*
Who are your preferred suppliers:
*
Relevant contacts
Mainline office number:
*
Format: (0000) 000-0000.
Escalation telephone number:
*
Format: (0000) 000-0000.
We believe in sharing information promptly and regularly, please provide relevant email addresses for the below areas:
Administration email address:
*
example@example.com
Compliance email address:
*
example@example.com
Reporting email:
*
example@example.com
Tariff updates:
*
example@example.com
Witness email address (this is required to countersign onboarding agreements and should be different to main contact):
*
example@example.com
Payment Details
Name of Bank:
*
Name On Account:
*
Account Number:
*
Sort Code:
*
Are you VAT Registered
*
Please Select
Yes
No
Vat Reg Number:
*
Have you registered with the Ombudsman ADR scheme
*
Please Select
Yes
No
ADR no:
*
ADR Renewal Date
*
-
Month
-
Day
Year
Date
Confirmation
Please provide us any other relevant information here in order for us to complete your application review:
*
Do you currently work with, or have you worked with UCR previously or one of our brokers? If so, who?
*
Do you consent to a credit check on you or your company?
*
Please Select
Yes
No
By signing and submitting this form you confirm that all the information given in this form is correct and to the best of your knowledge.
Full Name
*
First Name
Last Name
Position:
*
Date
*
-
Month
-
Day
Year
Date
Signature
*
In order for us to proceed your application we also require:
A form of photo ID
*
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Passport or Drivers licence
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Proof of address:
*
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Valid UK driving license Recent, utility bill (gas, electricity, water or landline phone), Council tax bill, Recent credit card or bank statement.Recent Building Society or Credit Union statement or Tenancy agreement.
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Director Verification:
*
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Photo of EACH director holding Valid UK driving license or Passport. These photos should be a well-lit photo of each director holding their IDs
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