Apply Today – ProActivLife – Personal Protection Experts

ProActivLife - Application Form

Hopefully, you have enjoyed our Induction Training and you are ready to take the first step on a new journey. The role of Financial Adviser is a highly responsible position of trust, diligence, and competence. We are committed to serving our clients with the highest standards, therefore we need to be sure that people who become our representatives share the same values.

Please prepare details described below before you will start filling the application, as the option to save and continue later is unavailable. You need about 10-20 minutes to complete an application form.

You'll need to provide information to cover at least 3 last years of your employment/study and residency within this application. Any gaps longer than 1 month must be clarified in writing in Section 6.
You’ll need to provide details of any business you own.

When completing the application form please read carefully all questions. Remember, that you must provide all required information with the best of your knowledge and with honest and reliable manners as we will process several checks and any dishonest answer might invalidate our future contract.

In particular circumstances, we may ask you to provide additional or more detailed information to clarify any indirectness. Otherwise, your application cannot be processed.

The information you supply in this application will form the basis of your contract with ProActivLife Ltd. Most of the information we ask for is prescribed by the Financial Conduct Authority (FCA).

The FCA considers the following of utmost importance for any role in the financial services industry:

Honesty, integrity, and reputation
Competence and capability
Financial soundness

Therefore, it is vitally important that the information you provide is 'full and frank'; we will need to verify this information to satisfy the FCA requirements.

Contracting Process

We want you to start trading without delay. Therefore, we will rely on the information you provide rather than waiting for a final reference from your previous company. We will still need this reference, and we will obtain it as soon as we can but in most cases, you will be able to start trading once you have signed a contract and we have confirmed your start date in writing.

Therefore, it is absolutely essential that you provide accurate information. If we subsequently discover you have made a material non-disclosure we will terminate your contract. This may appear in any future references we are asked to provide, making it difficult for you to work with any other Authorised Firm.

If there is anything that may be detrimental to your application, you must tell us and explain fully. If in any doubt: ask us!

If you wish to discuss this or have any other questions, please contact us at info@proactivlife.co.uk or call Piotr Nikonowicz 07840 166 325.

Section 1 – Personal Details

1.1 Full Name

Title

Forename(s)

Surname

1.2 Previous Names

If you are known, or have previously been known, by any other names or have a former name or surname, please enter full details

Title

Forename(s)

Previous Surname

Date of Name Change

Reason For Name Change

1.3 Date Of Birth

DD/MM/YYYY

1.4 Contact Details

Home Telephone

Mobile Phone

Email Address

1.5 Current Address

Address

Town

Post Code

Date From

1.6 Previous address

If you have not resided at your current address for more than five years, please enter previous address. Please use additional sheet if necessary. If you reside abroad please provide all addresses as well.

Previous Address 1

Town

Post Code

Date From

Date To

Previous Address 2

Town

Post Code

Date From

Date To

1.7 More Details

NI Number

Nationality

Place of Birth

If born outside the UK, how long have you lived in the UK?

1.8 Do you have full valid driving licence?

Yes No

1.9 Do you have an access to the car?

Yes No

1.10 I give my permission for Prolife Financial Services to conduct a Disclosure and Barring Service (Criminal Record Check) and Adverse Financial Checks

Yes No

If no, please state the reason:

Section 2 – Employment, Business and Education Activity

Please provide details of your complete employment / self-employment (full and / or part-time), unemployment, education for the last 3 years from the date you have completed your application. References will be requested from past and present employers.

If you were self-employed or company director of the Limited Company use this section to provide all details about your business activities. Additionally, we would require Accountant references confirming your business activity within that period or copies of HRMC Returns for that period.

If there is any employer you would prefer us not to contact at this stage, please let us know and give a full explanation under Additional Information section . Please note that in order to process your application we must request references from all previous employers in the last three years.

Please provide the full history starting from the most recent ones. If you will have any gaps longer than one month in your history please use Additional Information section for explanation. Do not leave any Blank Spaces.

2.1 Current Employer, Business or University

Name

Nature of Business

Address

Town

Post Code

Telephone Number

Email Address

Dates of activity

Date From

Date To

Other Details

Job Title

Employement Status
Employed Self Employed Unemployed Company Director Education

Are you still with that organisation
Yes No

Can we contact employer for a reference?
Yes No

If no, please tell us why

2.2 Previous Employer Business or University

Name

Nature of Business

Address

Town

Post Code

Telephone Number

Email Address

Dates of activity

Date From

Date To

Other Details

Job Title

Employement Status
Employed Self Employed Unemployed Company Director Education

Reason for leaving

Best person to contact for references

Can we contact employer for a reference?*
Yes No

If no, please tell us why

2.3 Previous Employer Business or University

Name

Nature of Business

Address

Town

Postcode

Telephone number

Email address

Dates of activity

Date From

Date To

Other Details

Job Title

Employement Status
Employed Self Employed Unemployed Company Director Education

Reason for leaving

Best person to contact for references

Can we contact employer for a reference?*
Yes No

If no, please tell us why

Section 3 – Company Directorship, Ownership and Business Shares (of any Limited Company)

Have you ever held ANY company Directorships, whether current or not? Or any current ownership and business shares
(Please provide ALL Directorships ever held)

directorshpopt
Yes No

If yes, please give details

Will the above Directorships continue?

directorshpcopt
Yes No

If no, tell us why?

If yes, please provide details of future intentions and the nature of your responsibilities

Section 4 – Accountant Details

(Please insert Accountant details if you have one. For Limited company or Self Employment - mandatory)

Title

Surname

Intials

Telephone

Fax

Email

Address

Town

Country

Post Code

How long has the above been your Accountant?

Date From

Date To

conf
I confirm that I did not use an accountancy services and I was submitted HMRC Self Assessments on my own. I can provide the copy of my Tax Returns.

Section 5 – Fitness and Propriety

Please answer all questions below. Where YES is selected, please provide full details in the Additional Information Section.

5.1.A

Have you ever been convicted of any offence involving fraud, theft, false accounting, offences against the administration of public justice (such as perjury, preventing the course of justice and intimidation of witnesses or jurors) serious tax offences or other dishonesty or an offence (whether or not in the United Kingdom) relating to companies, building societies, industrial and provident societies, credit unions, friendly societies, insurance, banking or other financial services, insolvency, consumer credit or consumer protection, money laundering, market manipulation or insider dealing? (Spent convictions for relevant offences must be disclosed in accordance with the rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (see Articles 3 and 4 of the Order))

opt51
Yes No

5.1.B

Are you the subject of any current criminal proceedings?

opt51b
Yes No

5.2

Have you any convictions for any offences, other than for those listed in 7.1 which are spent or not spent, whether or not in the United Kingdom (excluding traffic offences unless these resulted in a ban from driving or involved driving without insurance)

opt52
Yes No

5.3.A

Are you, or have you ever been the subject of any civil proceedings, arbitration or litigation, including proceedings that may lead to a County Court Judgement (CCJ) or other judgement debts in the United Kingdom or elsewhere?

opt53a
Yes No

5.3.B

If yes, is or was the total of judgement debts more than £5,000?

opt53aa
Yes No

5.3.C

Have you ever had more than 2 CCJ's or judgement debts?

opt53b
Yes No

5.3.D

Are you aware of any intention to begin such proceedings against you in the future?

opt53c
Yes No

5.3.E

If yes, is there more than one proceeding threatening?

opt53cc
Yes No

5.3.F

Do the amounts claimed total more than £5,000?

opt53d
Yes No

5.4

Do you have any judgement debts (including CCJ's) made under a court order still outstanding, whether in full or in part?

opt54
Yes No

5.5

Have you, or any company you have been associated with, failed to satisfy any such judgement debts within one year of the making of the order?

opt55
Yes No

5.6.A

Are you, or have you ever been , the subject of any bankruptcy proceedings, or proceedings for the sequestration of your estate?

opt56
Yes No

5.6.B

Have you ever entered into a deed of arrangement or an individual voluntary arrangement (or in Scotland a trust deed) or other agreement in favour of your creditors, or are you doing so?

opt6b
Yes No

5.7

Do you have any outstanding financial obligations arising from regulated activities, which you have conducted in the past, whether in the United Kingdom or overseas? In the case of Advisers, this will include any outstanding liabilities arising from commissions paid for the sale of packaged products that have lapsed.

opt57
Yes No

5.8

Have you ever been found guilty of conducting any unauthorised regulated activities or been investigated for possible conduct of unauthorised regulated activities?

opt58
Yes No

5.9

Have you ever, either in the United Kingdom or elsewhere:

5.9.A

been refused entry, or been dismissed or requested to resign from: any profession, vocation, office or employment, or from any fiduciary office or position of trust, whether or not remunerated?

opt59a
Yes No

5.9.B

been refused, restricted in, or had suspended, the right to carry on any trade, business or profession for which a specific licence, authorisation, registration, membership or other permission is required?

opt59b
Yes No

5.9.C

been disqualified by a court from acting as a director of a company or from acting in a management capacity or conducting the affairs of any company, partnership or unincorporated association?

opt59c
Yes No

5.9.D

been the subject of a disqualification direction under section 59 of the Financial Services Act 1986 or a prohibition order, under section 56 of the Financial Services and Markets Act 2000, or received a warning notice to make such a direction or order?

opt59d
Yes No

5.10

In respect of activities regulated by the FCA or any other regulatory body, have you or any company, partnership or incorporated association of which you are or have been a controller, director, senior manager, partner or company secretary, during the candidate's association with that entity and for a period of three years after the candidate ceased to be associated with it, ever:

5.10.A

been refused, had revoked, restricted or terminated, any licence, authorization, registration, notification, membership or other permission granted by any such body?

opt10a
Yes No

5.10.B

been criticized, censured, disciplined, suspended, expelled, fined, or been the subject of any other disciplinary or intervention action by any such body?

opt10b
Yes No

5.10.C

resigned whilst under investigation, or been required to resign from, any such body?

opt10c
Yes No

5.10.D

decided, after making an application for any licence, authorization, registration, notification, membership or other permission granted by any such body, not to proceed with it?

opt10d
Yes No

5.10.E

been the subject of any civil action which has resulted in a finding against the candidate, or it, by a court?

opt10e
Yes No

5.11

Has any company, partnership or unincorporated association of which you are or have been a controller, director, senior manager, partner or company secretary, in the United Kingdom or elsewhere, at any time during your involvement or within one year of such an involvement:

5.11.A

been put into liquidation, wound up, ceased trading, had a receiver or administrator appointed, or entered into any voluntary arrangement with its creditors?

opt511a
Yes No

5.11.B

been adjudged by a court liable for any fraud, misfeasance, wrongful trading or other misconduct?

opt511b
Yes No

5.11.C

been investigated or been involved in an investigation by an inspector appointed under companies, or any other, legislation, or been required to produce documents to the Secretary of State, or any other authority, under any such legislation?

opt511c
Yes No

5.11.D

been adjudged by a court liable for any fraud, misfeasance, wrongful trading or any other misconduct?

opt511d
Yes No

5.12

Are you, or have you ever been, the subject of an investigation into allegations of misconduct or malpractice in connection with any business activity?

opt512
Yes No

5.13

Have you ever been dismissed or asked to leave by any employer? Have you ever received any warnings, written or verbal, from any employer? If yes please explain in Section.

opt513
Yes No

Section 6 – Additional Information

If you would like to provide more information - please enter section number and insert details.

Section

Information

Section 8 – Declaration

I understand, that it may be a criminal offense to provide false or misleading information to the Financial Conduct Authority or Prolife Financial Services. Therefore, I affirm, that all questions in this application form have been answered fully and accurately. I understand that any information contained in the application or otherwise supplied by me/us may be shared with Prolife Financial Services for the purposes of processing this application and the Appointed Representative (if applicable) I am joining. I confirm that:

The information given in this application is accurate and complete, and all relevant details have been disclosed

I understand that the information disclosed may be used as the basis for deciding if I will be offered a contract with Prolife Financial Services

I give my permission for Prolife Financial Services to undertake a credit search with a licensed credit reference agency and acknowledge that the credit reference agency will keep a record of this search and may share this with other businesses.

I give my permission for Prolife Financial Services to take up any references that it considers appropriate in order to consider this application and I authorize that source to release the information requested. This may include contacting any Lender, Bank, Building Society, Accountant, Solicitor, past and present Employers, Unemployment Benefit Office or any other relevant party.

I understand that if there is any material change to my circumstances after the date of this application, I will promptly inform Prolife Financial Services

I understand I will be invited to attend training courses at a place advised by Prolife Financial Services, and that this invitation does not imply a commitment from Prolife Financial Services, to offer a contract upon completion of the training; nor does it imply a commitment on your part to proceed with your application. However, successful completion of the training courses is a precondition of the offer of a contract.

I confirm I will enter into an agreed repayment schedule, or full and final settlement, with any Financial Services debt.

I understand I am not authorized to represent Prolife Financial Services in any way until written confirmation has been provided by Prolife Financial Services.

If authorization is given by Prolife Financial Services, I will, at all times, comply with the FCA rules, and Prolife Financial Services policies and procedures.

I understand and give my permission to Prolife Financial Services to conduct an identity check from the information I have provided on my application form.

I understand and give my permission to Prolife Financial Services to conduct several checks including Disclosure and Barring Service (DBS), ID Check, Directorship Check, FCA Search and I may be charged for several checks.

I give my permission to ProLife Financial Services to obtain reference request on my behalf from my previous Employers or Companies I was co-operating with.

Data Protection

By submitting a completed Application Form, you consent to the processing of all data contained in said Application Form, as well as all data contained in your passport, other identifying documentation, or driver’s license (hereinafter referred to as Personal Data), so that ProLife Financial Services Ltd. may transfer your personal data or delegate the processing thereof under any contract or agreement with third parties.

The information you provide on this form including any sensitive personal details for example criminal convictions, will be used by Prolife Financial Services to assess your suitability for the contract you have applied for. This may include undertaking credit checks and seeking references for the purpose of verification, identification and in accordance with Prolife Financial Services regulatory requirements to ensure that you are fit and proper to perform the activities permitted under the contract. We may share your relevant personal information with other companies that Prolife Financial Services are or become associated with and agents acting on behalf of Prolife Financial Services to comply with our regulatory obligations and for ongoing administration, management information and marketing purposes.

Personal Data is provided to ProLife Financial Services Ltd., located at 3 Chester Bridge, Crewe, CW2 7EF and it’s principal Financial Expert Partnership Ltd located at 3 Chester Bridge, Crewe, CW2 7EF (hereinafter the Company), as well as to any entity delegated by the Company to process Personal Data, data confirmation etc.

The company may process Personal Data for the following purposes: Processing Adviser position application; creating an internal account for adviser; verification payment and vindication purposes and other needs company saw as needed for compliance purposes.

ch2

I hereby grant ProLife Financial Services Ltd to process my personal data for the purpose stated above.

ch2

I accept the terms and conditions of this application to Prolife Financial Services