APPLICATION TO BECOME AN INDEPENDENT OPERATOR (IO)/REMOTE SERVICES SUPPLIER (RSS)

APPLICATION TO BECOME AN INDEPENDENT OPERATOR (IO)/REMOTE SERVICES SUPPLIER (RSS)
SECTION 1 COMPANY DETAILS

Please complete as much information in this section as possible. This will help us to confirm ownership, eligibilty and evidence of working in the automotive area.
Company Name*
Full Address (Including postcode)*

Address Line 1

Address Line 2

City/TownCounty

Post Code
Managing Director Name*
Please state the name of the Managing Director, or equivalent person, with legal responsibility for the business.,
Main Contact Name*
This is the main contact at your organisation responsible for managing the SERMI UK approval process.
Main Contact Number*
This is the main contact at your organisation responsible for managing the SERMI UK approval process.
Main Contact Email Address*
A PDF of this application form will be emailed to this address once submitted.
Website Address*
Please add your website URL with http://www.
VAT No (if applicable)
If you are VAT registered, please add your VAT registration number here.
Companies House Number (if applicable)
If you are a Limited Company, please add your Companies House number here.
Is your Company a member of an Automotive Trade Association?

YesNo
Trade Association Name(s)
If you are a member of an Automotive Trade Association please add the name(s) here.
Company Start/Inception Date*

DayMonthYear
Business Type - Please select all that apply

Maintenance and RepairVehicle DiagnosticsVehicle Tuning/MappingMobile DiagnosticsRemote DiagnosticsAccident RepairOther
PUBLIC LIABILITY INSURANCE DETAILS

To become a SERMI UK Authorised Independent Operator you will need public liability insurance with a minimum of 1 million Euros (equivalent in GBP) coverage for bodily injury and 0.5 million Euros (equivalent in GBP) coverage for property damage. You will need to provide a copy of your insurance certificate with this application.
Start Date of Public Liability Insurance*

DayMonthYear
Date
Expiry Date of Public Liability Insurance*

DayMonthYear
Date - Please ensure you keep your Public Liability Insurance valid throughout your validity period (60 months)
Limit of Bodily Injuries Cover*
Please enter the limit of cover for bodily injuries in GBP
Limit of Loss or Damage to Property*
Please enter the limit of cover for loss or damage to proprty in GBP
Public Liability Insurance Policy No*
SECTION 1 DECLARATIONS
I confirm ownership of the above-named business and I have included evidence of this with this application.*

YesNo
I confirm that the above-named business is a ‘legitimate business’ and I have included evidence of this with this application.*

YesNo
I understand I need to prove activity in the automotive area and I have included evidence of this with this application.*

YesNo
I confirm that the named Managing Director (or equivalent) has a clean criminal record and I have attached a DBS certificate, dated within the last 6 months, to this application.*

YesNo
I confirm that the above-named Managing Director has completed and attached a Criminal Record Declaration form.*

YesNo
I confirm that the above-named business has never had SERMI approval declined or revoked.*

YesNo
I confirm that the above-named Managing Director has never had SERMI approval declined or revoked.*

YesNo
I can confirm that the Managing Director listed above has got a valid UK identity card, passport or driver's licence (they will need this to complete the Digital ID Verification).*

YesNo
SECTION 2 INDEPENDENT OPERATOR (IO) EMPLOYEES

Please note: The IO/RSS application fee includes the registration of one IO Employee. All additional IO Employees will incur an additional charge of £75+vat each and can be added by completing and submitting an IO Employee Application Form.
Employee Full Name

First NameLast Name
Employee Job Title
Descriptionof role, including responsibilities
SECTION 2 DECLARATIONS
I confirm that the IO Employee listed above has a clean criminal record.*

YesNo
I confirm that I have attached a DBS certificate, dated within the last 6 months, for the IO Employee listed above.*

YesNo
I confirm that I have attached a completed Criminal Record Declaration form for the IO Employee listed above.*

YesNo
I can confirm that the employee listed above has not had a previous authorisation revoked because of misuse of their authorisation.*

YesNo
I understand that any IO Employee with a criminal record or evidence of previously being revoked from the SERMI scheme will not be considered for approval and will not be able to access vehicle manufacturer security-related information.*

YesNo
I can confirm that the employee listed above has got a valid employment agreement or contract of employment and I will provide a copy with this application.*

YesNo
I can confirm that the employee listed above has got a valid UK identity card, passport or driver's licence (you will need this to complete the Digital ID Verification).*

YesNo
The IO Employee details MUST be checked, verified and signed by a legal representative of the Independent Operator/Remote Services Supplier named on the first page of this application (Company Details). It is their responsibility to check and confirm the validity of the IO Employee information, prior to submitting it to the Conformity Assessment Body (CAB).

Legal Representative Declaration

I confirm that the IO Employee information I have reviewed in this application form and any supporting documents are complete and accurate to the best of my knowledge. As a legal representative of the Company named in Section 1, I have the authority to sign this document on behalf of the organisation.
Legal Representative Signature*

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Legal Representative Full Name*

First NameLast Name
Legal Representative Job Title/Position*
Date*

DayMonthYear
Date
SECTION 3 FINANCIAL INFORMATION

Below you will find the fees associated with this application.
All prices are plus VAT
prevnext( X )
Initial Set-Up and Approval Fee Includes Independent Operator (IO) and one Authorised IO Employee
£360.00



Authorisation of Additional IO Employees
£75.00 Quantity



Random Unannounced InspectionTo be invoiced at the start of Year 2 (one per 60-month validity period)
£375.00



Arranged Site Inspection to Include Renewal FeeTo be invoiced at the start of Year 4 (within the last 6 months of validity period expiry date)
£375.00



Subtotal

£0.00

Tax

£0.00

Total

£0.00
Direct Debit Payments

If you would like to pay for your IO Authorisation, random unannounced inspection and arranged site inspections via Direct Debit, please complete the Direct Debit Mandate found here and attach it to the 'Upload Documents' section of this form.

The cost of the above can be split over the 60 month validity of your authorisation.
SECTION 3 DECLARATIONS
I understand that the approval will not be processed until the initial set-up and approval fee has been paid, or a Direct Debit mandate is returned.*

Yes
I understand that the Company listed in Section 1 will be invoiced at the start of Year 2 for the random unannounced inspection and the start of Year 4 for the arranged site inspection (and renewal fee), unless paying by Direct Debit.*

Yes
I understand that non-payment of any invoice may result in SERMI UK approval being revoked.*

Yes
SECTION 4 APPLICATION DECLARATION

Please review all the information provided within this application before signing the declaration and submitting it.
I can confirm that:
- The information I have given in this application form and any supporting documents are complete and accurate.
- I understand that failure to disclose any relevant information or the provision of false information may lead to refusal or revocation of SERMI UK approval.
- I have read the SERMI UK Terms and Conditions and I agree to their requirements.
Signature

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Print Name
Job Title/Position
Date

MonthDayYear
Date
UPLOAD DOCUMENTS

Please use this section to upload all the required documents to support this application.
Copy of Public Liability Insurance Certificate*

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Evidence of business ownership*

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Evidence of a 'legitimate' business*

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Evidence of activity in the automotive area

Only required if you are not registered on Companies House
Cancelof
Managing Director (or equivalent) DBS certificate*

Cancelof
Completed Managing Director (or equivalent) Criminal Record Declaration form *

Cancelof
Nominated IO Employee DBS certificate*

Cancelof
Nominated IO Employee completed Criminal Record Declaration form*

Cancelof
Nominated IO Emplyeee employment agreement/contract of employment*

Cancelof
Direct Debit Mandate (if applicable)

If you are paying via Direct Debit, please complete and upload a copy of the Direct Debit Mandate
Cancelof
Should be Empty:

APPLICATION TO BECOME AN INDEPENDENT OPERATOR (IO)/REMOTE SERVICES SUPPLIER (RSS)

SECTION 1 COMPANY DETAILS

PUBLIC LIABILITY INSURANCE DETAILS

SECTION 1 DECLARATIONS

SECTION 2 INDEPENDENT OPERATOR (IO) EMPLOYEES

SECTION 2 DECLARATIONS

SECTION 3 FINANCIAL INFORMATION

SECTION 3 DECLARATIONS

SECTION 4 APPLICATION DECLARATION

UPLOAD DOCUMENTS