| Please provide below as a percentage of where your business will be derived from | |
| Introducers | 0 |
| Client Retention | 33 |
| Client Referrals | 44 |
| Purchase of Leads | 0 |
| Other | 23 |
| If other, please provide details of source | Dental Practice |
| Introducers – if you have provided a percentage above for introducers, please provide the following: | |
| Name of Firm/individual | na |
| Will they be referring protection business | No |
| Will they be advertising your services | No |
| 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. | K Consultancy Services Limited. Company set as I was contracting. Business closed due to full time employment found under PAYE. No debt as a result of this. |
| Please provide details of any other business interests (if N/A, please state) | Utility Warehouse Partner for Utility Warehouse [UW]. |
| 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. | 40,000 |