Intermediary Network Registration Form

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About the Network
FCA Details & Procuration Fee Payments
The Network's Obligations

About the Network1/3

Please use this form to register your Network to enable mortgage business to be submitted to Monmouthshire Building Society (MBS) or to amend details of your existing registration.

Please note that all fields marked with an asterisk (*) are mandatory fields.

If you are completing this form as a Nominated Point of Contact for the Network, please provide us with your corporate email address below. *

Organisation

Please specify which details you wish to be amended: *

We will require a named individual on the FCA Register to verify you as a Nominated Contact.

An email will be sent to them from the Business Development Team to ensure that the Nominated Point of Contact on the registration form is authorised to manage future dealings.

Name of Principal Contact *

Principal Contact's Email Address *

If you are completing this registration as an FCA Registered Individual, please provide your details below so we can verify you from the FCA Register.

Name *

Email Address *

Name and Address of Network

Name of Network *

Limited Company Number *

Principal Place of Business

Address Line 1 *

Address Line 2

Address Line 3

Town/ City *

Postcode *

Telephone Number *

Intermediary Network Registration Form

About the Network1/3

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