Adviser registration form

Complete the form below to join Holloway Friendly. If you've previously registered, you can login here.

Register your details

Name*

Email*

Telephone*

Company name*

Network name

FCA Number*

Address line 1*

Address line 2

Town/City*

Postcode*

Address type

How did you hear about us?

Please specify

Are you authorised to sell IP on an advised basis?*

Yes

Anticipated monthly volume of IP written with Holloway Friendly?*

Approximately what percentage of your total business will be written with Holloway Friendly? (%)*

Commission may be paid on indemnity terms on written request, subject to approval.

The information you supply in completing and submitting this registration form will be used in considering your application to conduct business with Holloway Friendly in relation to non-investment insurance contracts.
We may need to carry out credit checks on you or any of the owners, partners, directors, executives and/or senior management of the Intermediary Firm. In addition to information you supply, we will also obtain publicly available data such as data available on the FCA register to verify the authorisations held by you and to examine its regulatory record. We reserve the right to perform credit searches and to search industry databases, such as the Elixir 2000 database, relating to your creditworthiness and that of any owner, partner, executive and/or senior management or if a sole trader, the sole trader.

By submitting this registration form you consent to Holloway Friendly carrying out any credit checks and confirm that your business owners, partners, directors and/or senior management are aware of this and have authorised you to consent to this on their behalf.

Details on how we use your personal information can be viewed in our Privacy Notice located here www.holloway.co.uk/kaleidoscope/terms-and-conditions.

Would you like to receive updates on our plans, pricing and changes to our underwriting?

Yes