Appointed Representative Application Form |

Appointed Representative Application Form

Thank you for considering rebuildingsociety.com Ltd as your Network Principal. Before we can onboard you as an appointed representative we will need you to complete the below application form.

Prior to an appointed representative (AR) joining rebuildingsociety.com Ltd’s network, it is necessary to establish whether the firm is suited to becoming an AR under the network and also whether the officers within the business can be considered ‘fit and proper’, as defined by the Financial Conduct Authority (FCA), and whether they constitute any form of business risk to rebuildingsociety.com and whether the partnership is a suitable arrangement for both businesses.

Rebuildingsociety.com is authorised to operate an electronic platform for the purpose of lending to businesses with client money management permissions. We currently do not offer AR permissions for the purpose of operating a equity crowdfunding platform nor for lending to consumers.

Upon receipt of your application, you will be invoiced the application fee of £5,000 + VAT. Payment is to be received before your application can be fully considered.

To assist you in completing the below application and to help you better understand the application process, we have created a guidance document.

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Application

1.Contact Details	[NOT STARTED]
2.Permissions and Business Plan	[NOT STARTED]
3.Firm’s Details	[NOT STARTED]
4.Regulatory Status	[NOT STARTED]
5.Trading and Share Structure	[NOT STARTED]
6.Finances	[NOT STARTED]
7.Firm’s Assets and Liabilities	[NOT STARTED]
8.Business Structure	[NOT STARTED]
9.Business Controllers	[NOT STARTED]
10.Firm Credit and Regulatory History	[NOT STARTED]
11.Declaration	[NOT STARTED]

1.Contact Details

Name of Main Contact Person:
Position:
Telephone Number:
Mobile Number:
Email Address:

2.Permissions and Business Plan

Please tick the most appropriate boxes:

As an AR we want to:
	Operate an electronic platform for lending to businesses
	Operate an electronic platform for lending to consumers
	Facilitate lending from retail lenders
	Facilitate lending from High Net Worth / Sophisticated lenders

Please in a few sentences describe how your platform will operate.

In order to fully assess your application, we will need to review your business plan. Please upload a business plan that covers at least the following points:

The structure of the funding you are planning to provide. Who will borrow, who will lend, what are the minimum loan amounts etc?
What is your 5 year plan for the business?
How do you intend to finance the business?
What is the experience of your management team?

Please upload your business plan below.

3.Firm’s details

Business Name:
Trading Name used or intended to be used by your firm:
Please list any other names that your firm has previously used:
Legal Status:
Incorporation Date (Ltd Co’s Only):
Registration Number:
Company Accounting Period:	From: To:

#	Director Name	Director Position / Department
1

Company Website URL:
Registered Address:
Is your trading address different from the above?
Trading address:

4.Regulatory Status of Company

Is your company currently directly authorised by the Financial Conduct Authority (FCA) or authorised as an Appointed Representative (AR) of another network or does your firm have a pending application for authorisation currently with the FCA?
FCA Firm reference Number (FRN):
Network Name and FRN (AR’s Only):

Please list the company name of any previous or current network principals that the applicant business is currently or has previously, been a part of.

#	Network principal Name	Period From	Period To
1

Has your firm been denied authorisation or AR status by any other network or regulator in the past?
Please add more information:

5.Firm Trading and Share Structure Details

Is your company part of a group or does it have any links with any other businesses?

#	Company Name:	Registration Number:
1

Please detail the share structure of the firm:

#	Name of Shareholder	Shareholding	Share Type
1

6.Firm Financial Details

Total budgeted income for the next 12 months:
Income from AR activities:
Income from other regulated activities:
Income from non-regulated activities:

Please upload a cash flow forecast for your business

7.Firm’s Assets and Liabilities

The assets and liabilities listed below should be that of the firm rather than any personal assets or liabilities. This section should only be completed by Limited Companies, LLP’s or Partnership firms.

Assets:

Freehold		Debtors
Motor Vehicles		Investments
Office Equipment		Cash in bank
Goodwill		Other (please specify)
Other
Total Assets:

Liabilities:

Trade Creditors		Loans, HP and Charge Accounts
Bank Overdraft		Mortgages and Secured loans
Taxation Liability		Other Outstanding Liabilities
Industry debt		Potential Indemnity Liability (If known)
Total Firm Liabilities:

8.Business Structure

Please provide an organisational chart of your firm detailing reporting and management lines between staff and department heads. Should your firm have close links with other supporting or linked businesses please explain their association.

Please provide the full name and contact details for all senior managers or department heads that work for your firm who are not applying as a Controller

#	Name:	Job Title:	Role and Responsibilities:	Email Address:
1

9.Business Controllers

Please provide details of all directors, principals, designated members and partners of the business. Each AR is required to designate at least one person as being responsible for the compliance of the firm with rules and regulations required of it.

Director / Principal / Controller 1:

Title:
Forename:
Middle Name(s):
Surname:
Job Title:
Percentage of Shares owned:
Email Address:
Role within company:
Is this person a director or majority shareholder of any other businesses?

Please list all current and previous directorships and shareholdings of 25% or more:

#	Company Name:	Registration Number:	Role:	Date From:	Date To:
1

10.Firm Credit and Regulatory History

1	Has the company ever been the subject of a receiving order, had a petition presented, or had a meeting called to consider a resolution, for winding up?
2	Has the company entered into any compromise agreement with its creditors, or proposed to make, a composition or voluntary arrangement with any one of more of its creditors?
3	Has the company been party to any civil proceedings, subject to a court judgement for a debt, had an administrator/trustee in bankruptcy appointed to it or had an application made for such an appointment?
4	Are you aware of any proceedings that have begun or anyone’s intention to begin proceedings against the company for a CCJ or another judgement debt?
5	Has the company had an application refused by another institution or any other insurance company?
6	Has the company ever been refused, had revoked, restricted, been suspended from or terminated, any licence, authorisations, registration, notification, membership or any other permission granted by any such body?
7	Has the company ever been removed from a lender panel or received a warning letter from a lender?
8	Has the company ever been criticised, publicly censured, disciplined, suspended, expelled or fined by the FCA, another regulator or Principal, a clearing house, an exchange, a professional body, or a government body or agency?
9	Has the company ever been the subject of an investigation into allegations of misconduct or malpractice, disciplinary proceedings by the FCA, another regulator or Principal, a clearing house, an exchange, a professional body, or a government body or agency or is aware that such proceedings are pending in connection with any business activity whether or not such an investigation resulted in a finding against the firm?
10	Has the company ever been the subject of a formal investigation under the powers in the Companies Acts 1985 to 2006 or been adjudged by a court civilly liable for any fraud, misfeasance, wrongful trading or other misconduct?
11	Has the company ever been the subject of an application to dissolve it or to strike it off the Register of Companies?
12	Have any firms that your business has links with ever ceased trading in circumstances in which any of its creditors did not receive full payment?
13	Does the company 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)?

If you have answered YES to any of the questions you must provide full details below (even if you have given the information before), clearly indicating the question or questions to which the details relate.

If there is any other information that you feel may be relevant to this application that may impact on your fitness and propriety that has not been asked on this application form, it must be detailed below.

Non-disclosure of any adverse information will result in your application being declined.

11.Declaration

I/We hereby authorise rebuildingsociety.com Ltd to seek further information from third parties as appropriate.
I/We confirm that the information provided in this application form is to the best of my/our knowledge and belief, complete and accurate.
I/We understand that the supply of any misleading information or any attempt to mislead rebuildingsociety.com Ltd will be an act of misconduct.
I/We will notify rebuildingsociety.com Ltd of any material change within this application whilst it is under consideration.
I/We understand that my/our appointment, as an Appointed Representative of rebuildingsociety.com Ltd shall only take effect when I/we and rebuildingsociety.com Ltd have signed the Appointed Representative Agreements.

Title:
Forename:
Surname:
Date:

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Account Details

Personal Details

Security Questions

How did you find us?

Terms and conditions

Appointed Representative Application Form

Thank you for considering rebuildingsociety.com Ltd as your Network Principal. Before we can onboard you as an appointed representative we will need you to complete the below application form.

Rebuildingsociety.com is authorised to operate an electronic platform for the purpose of lending to businesses with client money management permissions. We currently do not offer AR permissions for the purpose of operating a equity crowdfunding platform nor for lending to consumers.

Upon receipt of your application, you will be invoiced the application fee of £5,000 + VAT. Payment is to be received before your application can be fully considered.

To assist you in completing the below application and to help you better understand the application process, we have created a guidance document.

Application

1.Contact Details

2.Permissions and Business Plan

Please tick the most appropriate boxes:

Please in a few sentences describe how your platform will operate.

In order to fully assess your application, we will need to review your business plan. Please upload a business plan that covers at least the following points:

Please upload your business plan below.

3.Firm’s details

4.Regulatory Status of Company

Please list the company name of any previous or current network principals that the applicant business is currently or has previously, been a part of.

5.Firm Trading and Share Structure Details

Please complete the below section on group / associated companies.

Please detail the share structure of the firm:

6.Firm Financial Details

Please upload a cash flow forecast for your business

7.Firm’s Assets and Liabilities

The assets and liabilities listed below should be that of the firm rather than any personal assets or liabilities. This section should only be completed by Limited Companies, LLP’s or Partnership firms.

Assets:

Liabilities:

8.Business Structure

Please provide an organisational chart of your firm detailing reporting and management lines between staff and department heads. Should your firm have close links with other supporting or linked businesses please explain their association.

Please provide the full name and contact details for all senior managers or department heads that work for your firm who are not applying as a Controller

9.Business Controllers

Please provide details of all directors, principals, designated members and partners of the business. Each AR is required to designate at least one person as being responsible for the compliance of the firm with rules and regulations required of it.

Director / Principal / Controller 1:

Please list all current and previous directorships and shareholdings of 25% or more:

10.Firm Credit and Regulatory History

If you have answered YES to any of the questions you must provide full details below (even if you have given the information before), clearly indicating the question or questions to which the details relate.

If there is any other information that you feel may be relevant to this application that may impact on your fitness and propriety that has not been asked on this application form, it must be detailed below.

Non-disclosure of any adverse information will result in your application being declined.

11.Declaration