This is the Great British Finance affiliate application scheme
What the Great British Finance affiliate scheme wants from you
You can earn up to 50% commission when you join the Great British Finance business introduction and affiliate scheme

Company name:
    
Address:
Registered address:
(If different)
Email (required)
Telephone
Fax:
Website address
Nature of business
 
Date established
Company registration no'
Name:
Telephone:
Name:
Telephone:
Name:
Telephone:
Insurers name:
Amount of cover:
Renewal date:
Policy no.:
FSA Number:
Date issued:

Account name:
Account number:
Bank name:
Sort code:
Address:




    
Please answer the following questions:  
1. Have you, as an individual, director or partner ever had your registration or enrolment of any professional or statutory body denied or terminated?
(If 'Yes' please give details on a seperate sheet)
2. Have you, as an individual, director or partner, or has a fellow director or partner ever:  
(a) Had a similar agency with any other insurer/provider denied/terminated?
(If 'Yes' please give details on a seperate sheet)
(b) Been subject to disciplinary proceedings by a regulatory or professional body?
(If 'Yes' please give details on a seperate sheet)
(c) Been involved with any business that has gone into receivership or liquidation?
(If 'Yes' please give details on a seperate sheet)
I/We apply to join the affiliate scheme, and confirm that to the best of my/our knowledge and belief, the information given in this application is true and accurate. I/We agree to notify you of any changes in information/circumstances within the organisation.
I/We will ensure that all registered brokers, employees, consultants etc, will receive full training and product knowledge as required by the relevant regulatory body.
Name    
Position    
Date    
By clicking onto the 'submit' button below you agree to the above declaration, have authority to submit this online application on behalf of your company and allow us to use the information you have provided above (in conjunction with our affiliate companies) for the sole purpose of completing your application.

Great British Finance Limited are authorised and regulated by the Financial Services Authority (FSA). The FSA does not regulate some forms of Mortgage, Inheritance Tax Planning, Credit Cards, Personal Loans, Deposit Accounts & Insurance. If you are submitting an online request, we would advise to read our KeyFacts statement, links are at the top of this page.

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Got a question? email: support@greatbritishfinance.com
Phone: (+0044) 845 370 0020 Fax: (+0044) 845 370 0021
©2001-2007 All Rights Reserved. E&OE
Great British Finance Limited 19 High Street, Swadlincote, Derbyshire, DE11 8JE
Registered office: 81 Burton Road, Derby DE1 1TG
Registered in England No: 03171349