Intermediary Registration
Personal Details
Title
*
-- Select --
Miss
Mr
Mrs
Ms
Other
Title Description:
First Name
*
Last Name
*
Email Address
*
Confirm Email Address
*
Contact Details
Company Name
*
Flat / Unit:
Number / Building Name:
*
Street:
*
Next line of address:
Town:
*
District:
County:
Postcode:
Phone Number
*
Fax Number
Mobile Number
Preferred Contact Method
*
-- Select --
Email
Fax
Phone
Authorisation Details
FSA Number
*
CCL Number
*
FSA Permitted Activity
*
Arranging
Advising
FSA Status
*
Directly Authorised
Appointed Representative
Password Details
Password
*
Help
Passwords must be 6 to 20 characters with no spaces (case sensitive)
Confirm Password
*
Security Question
*
Help
You will be asked for the answer to your security question if you forget your password
Security Answer
*
Kensington may use your details to forward to you by post or email information about products
and services that may be of interest to you. We will not pass this information on to third
parties. If you do not want your details to be used then please check this box.
I have read the Kensington
Terms and Conditions
and agree to them.