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If you need any help or are not sure which category your firm would come under then please contact our Intermediary Sales Team on 0345 0615 700 Mon-Fri 9:00am-5:00pm, use the webchat button at the bottom right of your screen or our contact form. All information supplied on this form will be checked. If we’re missing anything, we’ll contact you to let you know. 


I’m from a directly authorised firm looking to sell and refer clients to Paymentshield

The firm I represent is directly authorised and we want to sell directly and refer clients to Paymentshield.


I’m from a directly authorised firm only wanting to refer to Paymentshield

The firm I represent is directly authorised and we just want to refer clients to Paymentshield (not sell directly.)

reaching out via treview site

Non regulated

I’d like to refer business to Paymentshield and the firm I represent is a non-regulated. 

Application for directly authorised Firms

This form is only for firms that are directly authorised by the Financial Conduct Authority (FCA) and should be completed by a controller.

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Firm details  

I wish to apply for a Paymentshield agency *

Can you confirm that your firm holds current professional indemnity cover? *

Please note: Your firm must hold personal indemnity cover to proceed with this application.


Is your trading address different from your firms registered address? *

Help text: We will send all correspondence to this address.

If you would like this application to be connected to a club or service provider, please click ‘Yes’ and select your chosen provider

Main contact at the firm

Controller information

A controller is the controller, owner, partner or director of the firm as stated on the FCA register.

Will this individual be arranging non-investment insurance contracts? *

Seller of non-investment contracts

If you would like to list additional sellers of non-investment insurance contracts, please click the 'Add a Seller' button below;

Add a seller?

Will this individual be arranging non-investment insurance contracts? *

Legal status of firm

Product Information

Is general insurance (GI) your firm's primary activity? *

Are more than 15% of your customers classed as vulnerable as described by the FCA? *

Have you or the firm been selling GI for longer than 12 months? *

Please select your reason for not having sold GI for longer than 12 months *

Banking details

This must match the firm’s name as stated in section one.

Commission details

When establishing a new Paymentshield agency, your commission method will default to Annualised Indemnity. If you wish to receive your commission payment in a different way, please select your preferred method below:

How would you like to receive your Paymentshield commission?

Commission statements will automatically be sent to the firm's main contact email address stated in step 1.


Has the firm had a receiver or administrator appointed, failed to satisfy a debt or reached an arrangement with any of its creditors or had a petition for bankruptcy or compulsory winding up of the firm? *

Has the firm or any of its controllers at any time been convicted of fraud or other dishonesty, or any offence under legislation, or sanctioned by a regulatory body? *

Are there any other significant events regarding the firm or any companies in the firm’s group that might adversely affect this application? *

I can confirm that my firm holds the following permissions through the FCA: Agreeing to carry on a regulated activity, Arranging (bringing about) deals in investments, Retail (Non-investment Insurance), Credit Broking, Making arrangements with a view to transactions in investments, Retail (Non-Investment Insurance) *

Please note: We cannot set up an agency without these permissions, however you can still submit the application and a Paymentshield representative will be in touch to discuss your options and requirements.


Declaration and data protection notification

Data protection notice

The personal information provided in this form may be “personal data” as defined in the current UK Data Protection Legislation
(UK GDPR and Data Protection Act 2018) and will be used by Paymentshield Limited. We may obtain further personal data about
you or your company from credit reference agencies, the Financial Conduct Authority (FCA) and/or other regulatory bodies. We
will use this information to decide whether to enter into the agreement with the company and then periodically whether to
continue with the agreement. We may use the information to administer our agreement with the company.

We may share all information we have about you with insurance companies, credit reference agencies, debt recovery agencies,
tracing services, the FCA and/or other regulatory bodies in order to protect our and others’ interests, and to prevent fraud. We may
use information that is not sensitive personal data as defined by the DPA for marketing purposes, and may share this information
within the Atlanta Group. 

When you provide us with this information you are consenting to our use of it as set out in this notice and that all conditions in the Data Protection Annex will be followed and adhered to. If you have questions about our use of personal information, or if you believe our records are inaccurate, you should write to the Data Protection Officer, Paymentshield Limited, Embankment West Tower, 101 Cathedral Approach, Salford, M3 7FB or email [email protected].

I confirm that I have read and understand the above data protection notice *

I, as stated in the controller section, can confirm I am the controller, owner, partner or director of the firm and the information in this form is complete and correct to the best of my knowledge, information and belief, and that there are no relevant facts of which the Paymentshield Group of companies and or alliance partners should be aware of *

I confirm that I have read the Agency Terms & Conditions and I hereby agree on behalf of the firm to be bound and comply with the obligations and requirements contained therein *

If you are requesting your Directly Authorised application to be affiliated to a DA Support Service Provider of Paymentshield, you confirm that you agree to us passing on any of your log in details for you to the affiliated Support Service Provider *