Registration form - Legal & General

Registration formNew companyXNew brokerXMoved companyXUpdate of detailsX(please tick all those that apply)please stateDetails about you and your companyYour nameTitleFirst name(s)SurnameYour contact details officemobilealternativefaxYour email address**we will use this to supply your online access detailsCompany nameCompany FSA numberPrincipal FSA number (if applicable)Consumer Credit Licence numberBranch addressPostcodeIf you have moved company recently, please complete this section. This will help us to keep our records up to date.Previous company nameFSA numberAddressDetails about how you would like to be paidPostcodeVia Mortgage Club* (please state which)*Please note we may require further informationVia Principal (please state which)

If there are additional brokers to be registered under the same firm, please give us theirdetails below.Details about youYour nameTitleFirst name(s)SurnameYour contact numbers officemobilealternativefaxYour email addressBranch address (if different)PostcodeDetails about youYour nameTitleFirst name(s)SurnameYour contact numbers officemobilealternativefaxYour email addressBranch address (if different)PostcodeDetails about youYour nameTitleFirst name(s)SurnameYour contact numbers officemobilealternativefaxYour email addressBranch address (if different)PostcodeUlster Bank Limited. Registered in Northern Ireland No. R733. Registered Office: 11–16 Donegall Square East, Belfast BT1 5UB. Member of The Royal Bank of Scotland Group.Authorised and regulated by the Financial Services Authority. Calls may be recorded. 5