Referral form

Your Title*

First name*

Last name*

Your contact number*

Your email address*

Your company's name*

FCA reference number*

Is your firm directly authorised with the FCA or are you an Appointed Representative?*

Directly AuthorisedAppointed RepresentativeIntroducer Appointed Representative

Is your firm a member of a compliance/business support service provider?*

YesNo

Please provide details of the compliance/business support service provider

Compliance/business support service provider name*

Please provide details of your Principal firm

Principal Firm Name*

Principal firm FCA number*

Please note that HUB will not appoint your company as an Introducer Appointed Representative and you are introducing the client under Exclusions 33A and 33B of the Regulated Activities Order.

Does your firm (or Principal firm if you are an Appointed Representative) already have an Introducer Agreement in place with HUB Financial Solutions Limited (previously known as Just Retirement Solutions Limited) to refer this type of business?*

YesNo

No problem – you can still go ahead and refer the client. However, you’ll need to have an Introducer Agreement in place to allow us to pay any introducer fees. We’ll be in touch to arrange this once you’ve referred the client.

Download the Introducer agreement

Client's title*

Client's first name*

Client's last name*

Client's date of birth*

Address Line 1*

Address Line 2

Town/City*

County*

Postcode*

Who are we calling?*

The clientA representative of the client who is authorised to act on their behalf

Name of client's representative*

Contact Number*

Email Address*

What's the best time for us to call?*

Morning (between 9am and 1pm)Afternoon (between 1pm and 5pm)

The primary need I'm referring the client for is (please select one):*

Retirement income planningEquity release advice

Notes

To avoid unintentional cross-selling, please indicate which of the following other areas of business you would be happy for us to handle for your clients (please tick all that apply):

Retirement income (annuities and drawdown)

Equity release

By referring this client, I confirm that:

I have not provided a personal recommendation on the area of advice for which I am referring the client, or the client has decided not to proceed with a recommendation I have provided.
I have authority from my company to make this client referral.
I have consent from the client or representative of the client to pass their personal data to HUB Financial Solutions Limited to contact them to provide the service requested in this form.
I agree to the relevant HUB Financial Solutions Limited terms of business and to how my data will be processed by HUB Financial Solutions Limited in accordance with the privacy policy.

I confirm that the above statements are true.

Ready to Refer? Fill in our Simple Form

Introducer Details

Introducer Company Details

Introducer Agreement

Client Details

Referral Details