Company application form

Are you joining an existing FSCL membership?

Are you joining an existing FSCL membership? *

If you would like to apply to an existing membership account, please either contact FSCL directly, or have your membership representative add you via the Member’s area of this website.

Member type

Member type *

Company details

Name of company *

Trading name (if different)

Company number

Website

FSP number *

Type of business

Number of employed advisers

Size of loan book

Amount of funds under management

Approximate amount of transactions in NZD per annum

Face value of securities

Amount of premium revenue per annum

Approximate transactions/lending amount per annum

Physical address

Street 1 *

Street 2

Suburb

City *

Postcode *

My postal address is different to my physical address

Postal address

Street 1

Street 2

Suburb

City

Postcode

Communications contact

Title *

Surname *

First names *

Known as

Email address *

Contact phone *

Mobile phone

Complaint contact

Use communications contact for complaints contact?

Title

Surname

First names

Known as

Email address

Contact phone

Mobile phone

How did you find out about us?

Confirmation

Position / Title *

Full name *

By applying for participation in the Financial Services Complaints Limited Scheme I agree that I have read and agree to be bound by the terms of participation and the scheme rules as set out in the terms of reference and FSCL's constitution. I agree to receive emails from FSCL and confirm that I am applying for membership from the date of this application. You can find our participation agreement, constitution and terms of reference on the publications page.

Agree *

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