Application

You are about to complete an application to join the Later Life Academy. Please answer all of the questions in full and we will contact upon receipt.

Later Life Academy

Application Form

Please complete the information below










Network Directly Authorised

CF7 CF8 CeRER CeLTM ER1 HR1


Long Term Care Annuities Equity Release Funeral Plans Wills

STATEMENT OF HONESTY, INTEGRITY AND REPUTATION
Please answer the following questions.
Where any questions are answered “Yes”, please provide full details below.
Are you, or have you ever been, the subject of, or are you aware of any intention to begin against you, either in the UK or elsewhere:
• Any civil proceedings, or litigation, including judgement debts or arbitration?
• Any bankruptcy proceedings, or proceedings for the sequestration of your estate, including entering into a deed of arrangement, an individual voluntary arrangement (or in Scotland a trust deed) in favour of your credits, or other composition, or arrangement with creditors?
If you have been the subject of any judgement debts under a court order, have you:
• Any such debts still outstanding, whether in full or in part?
• Failed to satisfy any such debts within one year of making of the order?
Have you ever, either in the UK or elsewhere:
• Been refused entry to any profession or vocation, or been dismissed or requested to resign from any office or employment, or from any fiduciary office or position of trust, whether or not remunerated?
• Been refused, or restricted in, the right to carry on any trade, business or profession for which specific licence, authorisation, registration, membership or other permission is required?
• Been disqualified by a court from acting as a director of a company or from acting in a management capacity or from conducting the affairs of any company, partnership or unincorporated association?
Have you, or has any company, partnership, or unincorporated association of which you are or have been a controller, director, partner, manager or company secretary, whilst you were associated with that entity and for a period of three years after you ceased to be associated with it, in respect of activities falling within the jurisdiction of a Regulatory Authority or any other professional body, ever:
• Been refused, had revoked, restricted or terminated any licence, authorisation, registration, notification, membership or other permission granted by any such body?
• Had a complaint upheld against you
• Been criticised, censured, disciplined, suspended, expelled, fined, or been the subject of any other disciplinary or intervention action by any such body?
• Resigned, or been asked to resign, from any such body or, after making a notification or application for any licence, authorisation, registration, membership or other permission granted by any such body, decided not to proceed with it?
• Been the subject of any civil action which has resulted in a finding against you or it by a court?
• Knowingly been the subject of an investigation into allegations of misconduct or malpractice in connection with any business activity?
Has any company, partnership, or unincorporated association of which you are or have been a controller, director, partner, manager or company secretary, in the UK or elsewhere, at any time during your involvement:
• Been adjudged by a court liable for any fraud, misfeasance, wrongful trading or other misconduct towards a Regulatory Authority or towards any members or creditors of a Regulatory Authority?
• Been investigated by an inspector appointed under companies or any other legislation, or required to produce books and papers to the Secretary of State?

DECLARATION
To the best of my knowledge, information and belief the details provided by me are correct. I am aware that Later Life Academy may request on a random basis and at any time copies of certificates of qualification and PI Cover. In any event copies of these will be required prior to Graduation from the Academy.

By ticking here I agree with the above statement

Once your form has been accepted and checked we will issue with a direct debit mandate and a contract, this formulates an official agreement.

Date:

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