Work With Us - Directly Authorised

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.

If you need any help completing this form please contact our Intermediary Sales Team on 0345 0615 700 Mon-Fri 9am-5pm.

All information supplied on this form will be checked. If we’re missing anything, we’ll contact you to let you know.

Section 1 - Firm Details

Please note: Your firm must hold Personal Indemnity cover to proceed with this application.


We will send all correspondence to this address.

Main Contact at the Firm

The main contact is the individual at your firm who Paymentshield should discuss the application with.

Section 2 - Controller & Seller Information

Controller Information

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

Controller 1

Add another Controller

Controller 2

Add another Controller

Controller 3

Add another Controller

Controller 4

Sellers 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

Seller 1

Add another Seller

Seller 2

Add another Seller

Seller 3

Add another Seller

Seller 4

Section 3 – Legal Status of the Firm

Legal Status of Firm

Section 4 – Product Information

Product Information

Section 5 – Banking Details

Banking Details

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

Section 6 – Commission Details


Section 7 – Disclosure


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

Section 8 – Declaration and Data Protection Notification

Declaration and Data Protection Notification

Data Protection Notice

The personal information provided in this form may be 'personal data' as defined in the Data Protection Act 1998 (DPA) and will be used by Paymentsheild Limited. We may obtain further personal data about you or your firm 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 firm and then periodically whether to continue with that agreement. We may use the information to administer our agreement with the firm.

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 Towergate Group.

When you provide us with this information you are consenting to our use of it as set out in this notice.

If you have questions about our use of personal information, or you believe our records are inaccurate, you should write to the Data Protection Officer, Paymentshield Limited, PO Box 229, Southport, PR9 9WU

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.

Need Help?

  • Call our INTERMEDIARY SALES TEAM on 0345 0615 700
  • Monday - Friday
    9am - 5pm