Broker / Intermediaries Contact Details: Your Name (required) Your Trading Name Your Email (required) Your Contact Details (required) Your Fax Number Your Position Additional Contact Name Additional Contact Details Company details Company Name (if different from the trading name) Company registration Number (If Ltd.) Regulation / Consumer Credit Licence License Number Date issued Date of Expiry Regulation / Financial Conduct Authority Are you Regulated by FCA? YesNo If yes, please provide us with your FCA Registration Number Regulation / Money Laundering Do you conduct Anti-Money laundering checks with your clients? YesNo Principal types of Finance What are the principal types of finance that your firm operates in? Please attach a copy of your Consumer Credit Licence when submitting this form. 2+8=?