| Please provide below as a percentage of where your business will be derived from | |
| Introducers | 0 |
| Client Retention | 30 |
| Client Referrals | 30 |
| Purchase of Leads | 10 |
| Other | 30 |
| If other, please provide details of source | new business leads from self generated business and marketing |
| Introducers – if you have provided a percentage above for introducers, please provide the following: | |
| Name of Firm/individual | |
| Will they be referring protection business | |
| Will they be advertising your services | |
| Please provide details of ALL companies where you have been a director, company secretary or shareholder.
If the company has dissolved, please provide full details including the reason for dissolution and if there was any debt as a result of this. If N/A, please state. | |
| Please provide details of any other business interests (if N/A, please state) | |
| Please indicate how much income you expect to generate over the first 12 months (after becoming an Appointed Representative), that is derived from non-regulated, non-financial services activities. | |