Online Application 1234 Apply to become a member of Financial Services Complaints Limited Thank you for choosing to join FCSL. To submit your application, click Next, then complete the form.Add another company or individual to your application for membership. To submit your application, click Next then complete the form.This field is hidden when viewing the formAre you joining an existing FSCL membership?This field is hidden when viewing the formAre you joining an existing FSCL membership? No Yes This field is hidden when viewing the formExisting FSCL membership number(Required)This field is hidden when viewing the formSection Break – Membership representativeWe’ll need written confirmation from the membership representative to add you to the membership. Alternatively, you can have your membership representative add you via the Member portal on our website. Applicant detailsIs your application for a Company or Individual?(Required) Company Individual Member/service type(s)(Required) Financial Advice Provider (FAP) / Authorised Body (AB) or Broker firm Financial Adviser or Broker (individual) Lender Transactional Service Provider Insurer Fund Manager Issuer of Securities Charity or Non-Profit organisation Credit Union Crowd Funder or P2P Lender This field is hidden when viewing the formMember/service type(Required)SelectFinancial Advice Provider (FAP)/Authorised Body (AB) or Broker FirmFinancial Adviser or Broker (individual)LenderTransaction Service ProviderInsurerFunds ManagerIssuer of SecuritiesCharity/Not for Profit organisationCredit UnionCrowd Funder or P2P LenderIf you engage any advisers under your Financial Advice Provider (FAP) licence, we’ll need you to provide information for the adviser(s) in an additional form. If this is the case and you haven’t already completed a form for any additional advisers, please select ‘Yes’ when asked if you would like to add a company or individual to the application at the end of this form.To apply for membership for a licensed Financial Advice Provider (FAP) or Authorised Body (AB), we need you to provide information for any other ABs and the adviser(s) that will be covered by the membership, even if it’s a sole adviser business. If you haven’t already completed a form for any advisers, please select ‘Yes’ when asked if you would like to add a company or individual to the application at the end of this form.Will you be applying for membership for a licensed FAP or Authorised Body?(Required) Yes, I will complete another application form for my FAP/AB No, I will hold a separate DRS membership from my FAP/AB I’ve already completed a form for my FAP/AB All FSPs that will list FSCL as their dispute resolution scheme on the FSPR will need to hold FSCL membership. Please select ‘Yes’ if you will also be applying for FSCL membership for your FAP/AB. You’ll be redirected to complete another form when this is submitted. Please select ‘No’ if you will hold a separate DRS membership from your FAP/AB Please confirm the company name(Required)Name of company(Required)Surname(Required)First names(Required)Known asTrading name (as on FSPR)FSP number(Required)Company numberEmail address(Required) Email address(Required) Contact phone(Required)Mobile phoneWebsite Would you like to be added to our digital mailing list? Yes No This will include webinar invitations, newsletters, and other FSCL news and updatesFurther informationNumber of advisers/brokers(Required)We’ll need you to complete an additional form for each adviser that will be covered by the membership, even if it’s a sole adviser business.Size of loan book(Required)Loan book less than $1mLoan book $1m-$10mLoan book $10m-$100mLoan book $100m – $250mLoan book $250m – $750mLoan book $750m – $1,000mLoan book greater than $1,000mApproximate amount of transactions in NZD per annum(Required)Transactions less than $5m paTransactions $5m – 500m paTransactions $500m – $2,000m paTransactions more than $2,000m paAmount of premium revenue per annum(Required)Premium revenue less than $70mPremium revenue $70m – $200mPremium revenue exceeding $200mAmount of funds under management(Required)Funds under management less than $10mFunds under management $10m – $100mFunds under management $100m – $500mFunds under management $500m – $2,000mFunds under management exceeding $2,000mFace value of securities(Required)Face value of securities less than 50mFace value of securiteis $50m – $200mFace value of securities exceeding $200mApproximate transactions/lending amount per annum(Required)Transactions/Lending amounts less than $1mTransactions/Lending amounts $1m – $8mTransactions/Lending amounts $8m – $50mTransactions/Lending amounts exceeding $50mTypes of financial services providedIn your own words, tell us a little about the financial service you provide Physical addressStreet 1(Required)Street 2SuburbCity/Town(Required)Postcode(Required)Use the same physical address for my postal address Use the same physical address for my postal address Postal addressStreet 1(Required)Street 2SuburbCity/Town(Required)Postcode(Required)Communications contactSomeone who can support us in membership enquiries and receive invoices.Surname(Required)First names(Required)Known asEmail address(Required) This email address will be used for all communications related to your membership application.Contact phone(Required)Mobile phoneUse communications contact for complaints Use communications contact for complaints Complaints contactSomeone who we can contact for our complaints referral process. These contact details will be visible to the public on our website.Surname(Required)First names(Required)Known asEmail address(Required) Contact phone(Required)Mobile phoneWould the complaints contact like to be added to our digital mailing list? Yes No This will include webinar invitations, newsletters, and other FSCL news and updatesProfessional association or groupAre you a member of a professional association or group?-Select-NoYesIf yes, please send through proof of membership with your professional group or association. This can be a membership certificate or written confirmation from the professional group/association.This field is hidden when viewing the formWhat is the professional association you are a member of?-Select-IBANZWhat is the professional group or association you are a member of?-Select-IBANZKiwi Adviser NetworkMike Pero MortgagesMortgage ExpressMortgage LinkmySolutionsNewparkNZACUNZbrokersNZ Financial Services GroupPAAPSC ConnectSHAREHow did you find out about us?ConfirmationFull name(Required)I confirm that: > I have read and agree to be bound by the scheme rules as set out in FSCL’s Terms of Participation and Terms of Reference. > I understand and agree that the entity that holds the FSCL membership is responsible for any financial service providers added to the membership. See our Terms of Participation and Terms of Reference.Agree(Required) Agree Would you like to add a company or individual to your application?(Required) No Yes Your application will be submitted and you will be redirected a new form where you can add another company or individual to your application for membership.Your application will be submitted without adding any further companies or individuals to your membership application.