LET ME TAKE YOU BY THE HAND...

LET ME TAKE YOU BY THE HAND... FCA Consumer Credit Limited Permission Application Guidance for Non Sole Trader Practices Click here to get started! medenta putting finance into practice

Contents... Page 2 Click on the page title to be directed straight to the page... Section 1 Introduction to the Guide.... 4-5 Accessing the System... 6 Starting the Application... 7-8 Section 1A The New Authorisation Form... 9 Application for Consumer Credit Core Details Form.... 10-11 Contact Details and Timings for the Application... 12-14 About the Applicant Practice... 15-19 Practice Contact Details.... 20-21 Trading Names and Other Names.... 22 Scope of Permissions Required... 23-28 Fees and Levies... 29 Regulatory Business Plan... 30-32 Financial Resources.... 33 Systems and Controls.................................... 34 Personnel... 35 Compliance Arrangements... 36-37 Disclosure of Significant Events... 38-45 Section 2... 50 General Guidance... 51 Specific Guidance Legal Status of the Applicant Practice (Q2.5)... 52 Trading Names and Other Names (Q4).... 53 Fees and Levies (Q6).... 54-55 Regulatory Business Plan (Q7.1).... 56 Business Risks (Q7.3)... 57 Treating Customers Fairly (Q7.4).... 58-59 Financial Resources (Q8.2)... 60 Personnel (Q10.1)... 61 Compliance Arrangements (Q11.1).... 62 Compliance Monitoring Programme (Q11.2)... 63 Financial Crime (Q11.3).... 64 Market Conduct (Q11.4)... 65 Disclosure of Significant Events (Q 12)... 66 Section 1B Approved Person Application What is an Approved Person?... 47 What are the Responsibilities of the Approved Person?.... 48 Completing the Application Process... 49

Hello - my name is Fred... Page 3 I ll be guiding you through the completion of this form - the Financial Conduct Authority s (FCA) consumer credit application for Limited Permission authorisation. I hope I can give you some guidance and tips to get through it. It s not as daunting as you first think... Here are a couple of things to look out for: Where you see this symbol, there is additional guidance specific to that part of the form...click the symbol to go to the right part. This symbol indicates a particularly important part of the form, please pay careful attention here. Click this in the top left corner to go straight back to the contents page.

This guide... Page 4 What this guide aims to do Resources Who is the guidance for? Reliance on this guide Its aim is to walk you through completion of the application form (Section 1) and provide practical assistance to aid you in complying with the obligations placed on you under the FCA authorisation regime. The FCA expects you, the applicant, to be ready, willing and organised to carry out regulated consumer credit activity on the day you submit your application form. We have therefore also included highlevel guidance on the various policies and governance documentation that you will need to have in place (see Section 2). The FCA also provides several sources of information which could assist you including: The FCA website: www.fca.org.uk/firms/firm-types/consumercredit The FCA Handbook: www.fshandbook.info/fs/index.jsp The FCA Customer Contact Centre: 0845 606 9966 or firm.queries@fca.org.uk This guide has been prepared for all practices who are not sole traders and who are only undertaking Limited Permission Credit Broking activities (the regulated activity required to offer Medenta patient finance). This guidance applies to partnerships, limited companies and limited liability partnerships (LLP). Further guidance on legal status definitions is provided in Section 2 of the guide. If you are making an application on behalf of a practice which is a sole trader, please use the guide entitled FCA Consumer Credit Limited Permission Application Guidance for Sole Trader Practices. This is an informative guide based on our current understanding of the new regulatory regime. Whilst we have used all reasonable care in the creation of this guide, we cannot accept liability for any errors or omissions in the content. This should not be viewed as legal or professional advice, if you have any specific issues, you should seek independent advice. If you are applying for credit categories other than Limited Permission Credit Broking, this guide may not be applicable so please get advice before proceeding. To understand the categories and to establish which are most appropriate for your practice, please view the FCA Toolkit: www.fca.org.uk/your-fca/documents/creditready-decision-tool We are happy to help with any general enquiries and can recommend compliance support if needed. Please contact Medenta on 01691 684138.

So, let s get started... Page 5 Before you start the online application there are a few things you need to ensure you have in place. These include: Basic details Business plan Business information Regulatory information Previous Office of Fair Trading (OFT) licence number and any current FCA reference numbers (if applicable). Company registration details (if applicable). National Insurance or passport number for any approved persons. This will need to set out your business aims and objectives and how you will organise your financial resources to achieve them. If you do not have a business plan or have not revised your current one for some time, you should start working on this now. For further guidance on developing a Regulatory Business Plan refer to Section 2. Business documents, such as draft agreements, pre contract information, promotional literature and website format. Financial projections on credit income. A staff organisational structure chart showing senior managers, decision makers and reporting lines. A compliance monitoring programme document. Locum arrangements (if applicable), including disaster recovery arrangements and a document setting out your business continuity procedures in the event of an emergency. Which regulated activities you are applying for (i.e. Medenta patient finance requires Limited Permission Credit Broking only). Agreement on who will be the approved person within the business that will perform a controlled function and evidence of their competence see Section 1B for further details. Employment history for the past five years, residential addresses for the past three years and details of any significant events for each approved person. Details of any controllers or close links. Details of partners, shares, subordinated loans or other external funding as appropriate. Contact details for auditors, accountants and professional advisors (as applicable). How your practice will manage risks from money laundering or market abuse, and who will be the firm s money laundering reporting officer if applicable).

Accessing the system... Page 6 You complete the application form online using the FCA Connect system, accessible through the following link: Apply now You will need to complete the following forms: (1) Limited Permission New Authorisation application form (2) Approved Person application form. Guidance on the completion of these forms is set out in Section 1 of this guide. We would recommend that as you work through the application process you use the FCA s Limited Permission application checklist, which can be found at: www.fca.org.uk/static/fca/documents/limited-permission-checklist.pdf When you click on Apply now, if this is your first time on the FCA Connect system, you will need to select Register to Authorise a New Firm. Enter your contact details and you will be emailed a link to create a password. This will then allow access to the system. Please note - the layout of the Connect system is different from the example application forms that have been provided by the FCA and not all questions will be posed. Use Section 1 of this guide as an aide to complete the application form but be aware the order and number of questions may differ depending on your responses in the live system.

Starting your application... Page 7 Once you are in the system you will need to accept the FCA terms and conditions and then select Start New Application. Then select Apply to authorise a new firm You will then be presented with the following menu, which will dictate the content and complexity of the questions within the application. If you only require patient finance, you need to select Limited authorisation. If you currently have an IP or have previously held a Consumer Credit Licence, then answer to previously traded. Also confirm your sole trader status.

You can now complete your application... Page 8 This is the front menu showing the sections to be completed and your progress through the application. You will find any ancillary applications that you need to complete, such as an Approved Person application under Related Applications. Please note that the subsequent forms will only become live when the previous form has been completed in full. Upon completion of all relevant sections above, select Add Related Application and select from the menu. PLEASE NOTE: You will not be able to submit your application until all relevant sections have been completed.

Section 1A Page 9 Now complete the New Authorisation Form... This section gives you guidance on how to complete the form, with some notes and tips along the way. Remember, where you see this sign, click for specific guidance notes!

The New Authorisation Form Page 10 Application for Consumer Credit Core details form 1 Contact details and timings for this application If your business is incorporated (Limited or LLP status) please enter the registered business name as listed at Companies House. For other legal entities this should be the main trading name. Application for Consumer Credit Limited Permissions Authorisation Core details form Full name of applicant firm Dental Practice Name Ltd Important information you should read before completing this form We require all applicant firms to provide these core details as part of their application for authorisation (known as Part 4A permission). Please keep a copy of the forms you complete and the supporting documents that you include with this application pack for your future reference. The notes that accompany this form will help you complete the questions and they also explain why we require the information we ask you for. For the purposes of complying with the Data Protection Act 1998, please note that any personal information provided to us will be used to discharge our statutory functions under the Financial Services and Markets Act 2000 (FSMA) and other relevant legislation and may be disclosed to third parties for those purposes. It is important that you provide accurate and complete information and disclose all relevant information. If you do not, it will call into question your suitability to be authorised, and you may be committing a criminal offence and could face prosecution under section 398A of the FSMA regardless of the status of your application. Terms in this application pack In this application pack we use the following terms: 'you' refers to the person(s) signing the form on behalf of the applicant firm; 'the applicant firm' refers to the firm applying for authorisation; we, us or our refers to the appropriate regulator; the FCA' refers to the Financial Conduct Authority; the PRA refers to the Prudential Regulation Authority; and FSMA refers to the Financial Services and Markets Act 2000. Please read this section carefully. Purpose of this pack We will only authorise a firm if we are satisfied that it meets conditions known as the threshold conditions (COND 2.2). The information in this pack is required to enable us to assess whether the applicant firm satisfies the threshold conditions. Contents of this form 1 Contact details and timings for this application 3 3 Personnel 12 2 About the applicant firm 5 4 Systems and controls 13 FCA Application for Credit Authorisation SPECIMEN Limited Permissions April 2014 page 1

Page 11 1 Contact details and timings for this application A permanent copy of the application should be retained by the applicant. The applicant will be required to print and sign a declaration for their own records. The declaration serves to confirm that the applicant understands that it is a criminal offence under section 398 of the Financial Services and Markets Act 2000 to knowingly or recklessly provide the FCA with false or misleading information. Filling in the form 1 If you are using your computer to complete the form: use the TAB key to move from question to question and press SHIFT TAB to move back to the previous question; and print out all the parts of the form you have completed and sign the declaration in the 'checklist and declaration' form. 2 If you are filling in the form by hand:- use black ink; write clearly; and sign the declaration in the 'checklist and declaration' form. 3 If you think a question is not relevant to you, write 'not applicable' and explain why. 4 If you leave a question blank, do not sign the declaration or do not attach the required supporting information without telling us why, we will have to treat the application as incomplete. This will increase the time taken to assess your application. 5 If there is not enough space on the forms, you may need to use separate sheets of paper. Clearly mark each separate sheet of paper with the relevant question number. 6 Post the application consisting of: this core details form; one supplement; You should ensure that you are completely certain as to the accuracy of all the questions answered and where appropriate, can demonstrate your answer with the relevant evidence. any appendices you need to complete; the checklist and declaration form; supporting documents; and the application fee to either the FCA or PRA at: Credit Authorisations Division The Financial Conduct Authority 25 The North Colonnade Canary Wharf LONDON E14 5HS FCA Application for Credit Authorisation SPECIMEN Limited Permissions April 2014 page 2

Page 12 Contact details and timings for the application 1 Contact details and timings for this application The information you provide will be held on record by the FCA and forms the basis of your contact with them. Any subsequent alterations require submission of a formal application so please ensure 100% accuracy. The contact for the application would generally be an individual such as the practice manager, and as such, the person who completes this application. 1 Contact details and timings for this application We need this information in case we need to contact you when assessing this application. Contact for this application 1.1 Contact details of the person we will get in touch with about this application. This must be someone who works for the applicant firm, and not a professional adviser. Title First names Last name The named person, or contact should generally be someone in the UK. Please enter the contact person s full name from their birth certificate or marriage certificate. Job title Address line 1 Address line 2 Address line 3 Town County Postcode Country Are the contact person s address details the same as the dental practice place of business? If not, please enter the contact details here. Telephone number Method of contact: only enter details if in regular use, for example, fax. The regulator needs to know how best to contact you. Mobile number Fax number Email address FCA Application for Credit Authorisation SPECIMEN Limited Permissions April 2014 page 3

Page 13 Contact details and timings for the application...continued 1 Contact details and timings for this application Professional advice and assistance may be sought, both with the application form and also with regulatory returns and ongoing compliance matters. If you are using a third party adviser, please include details here. If no adviser is involved, we would recommend you put Medenta contact details in this section. Whilst we do not hold ourselves out to be a professional adviser, by ensuring we are notified of the progress of your application, we can update our records and those of Hitachi Capital (UK) PLC (the lender) to reduce the administrative burden on you. The ultimate responsibility lies with the individual who signs the online declaration when submitting the completed application form. The regulator will always deal directly with the applicant for any queries. The applicant is responsible for ensuring all answers are completed fully and honestly. Whilst Medenta will assist you in the submission of the application, we will not be providing ongoing services. Only tick this box if you are using a third party. Details of professional advisers 1.2 Have you used a professional adviser to help with this application? No Continue to Question 1.7 x You must fill in the rest of this section 1.3 Name of professional adviser's firm Medenta Finance Limited 1.4 Name and contact details of professional adviser Title First names Surname Business address Postcode Phone number (including STD code) Fax number (including STD code) Mobile number (optional) Email address Cambrian Works Gobowen Road Oswestry Shropshire SY11 1HS info@medenta.com 01691 684138 0844 335 1961 1.5 Do you want us to copy all correspondence to the professional adviser? No x 1.6 If the applicant firm becomes authorised will it use a professional adviser (the adviser listed above or another one)? x No Providing copy correspondence: where this is Medenta, there is no charge for this support service and it will reduce the administration burden. FCA Application for Credit Authorisation SPECIMEN Limited Permissions April 2014 page 4

Page 14 Contact details and timings for the application...continued 1 Contact details and timings for this application For new applicants, only include a date if there is a key target date, for example running an advertising campaign or product launch. As soon as possible or an unrealistic time period (i.e. less than three months) is not an appropriate request. For existing licence holders, there is no need to specify a particular date as consumer credit activity can still be undertaken under the interim permission until the application is approved. The time taken to determine each application is significantly affected by the quality of the application submitted and whether it is complete. 1.7 Is there a date you would like this application to be approved? No Enter date required Please explain why We cannot guarantee to determine your application by a specific date but we will try to take into account any timings above when assessing your application(s). We must determine an application within the statutory timescales that relates to the application that has been submitted. Please bear in mind that the regulator aims to make decisions about your application as soon as possible and is required by law to determine completed applications within six months of receipt. FCA Application for Credit Authorisation SPECIMEN Limited Permissions April 2014 page 5

Page 15 About the applicant practice 2 About the applicant firm The applicant firm is the practice applying for authorisation. Please enter the name of the practice, or limited company or LLP name, if incorporated. There are regulatory controls relative to the names used by practices applying for authorisation, see Section 2 Trading Names and Other Names for further details. If you consider that there may be concerns over the current name, or are preparing to make any changes to the name of the practice, please seek guidance from Medenta. 2 About the applicant firm We need to know general information about the applicant firm so we can process this application as efficiently as possible. We also need the applicant firm's details for the Financial Services Register, which is our public record of authorised firms: www.fca.org.uk/pages/register/ 2.1 Firm Name Dental Practice Name Ltd Note: If you are applying as a sole trader this must be your personal name. If this is an incorporated firm then this must be the full current name registered at companies house. If the firm is a sole trader, the registered name of the firm that will appear on the FCA register will be the individual s name and not the trading 2.2 Does the Applicant have an interim permission (IP) for consumer credit? (Please note that IP holders are unable to submit an application for authorisation until their application period or landing slot commences but that they are able to use the system to draft their application in advance of this). Note: An interim permission to continue business may have been granted to a firm between the period of September 2013 to April 2014. A consumer credit interim permission reference number will have been provided No For existing licence holders, you should have received a letter and email confirming the date of your application period, typically a three month period. The letter will also include a reference number referred to as the interim permission number. We would expect in most circumstances that the response to question 2.3 should be No as no activities should take place before you become authorised and you should ensure you have the appropriate credit categories, i.e. for Medenta, credit brokerage, before undertaking credit activities. If, however, you consider the answer may be yes, you should seek legal advice. 2.2.1 Please provide the Applicant s consumer credit interim permission reference number (or former OFT licence number) 2.3 Has the applicant completed any credit agreements with consumers prior to becoming authorised or that are outside of the scope of its current Consumer Credit interim permission (if applicable)? No 2.4 2.3.1 Has the applicant applied (or is the applicant going to apply) for a validation order relating to these agreements? (a validation order also covers an application for compensation / to keep repayments of an unauthorised loan) No Please provide an explanation Note: please include the number or agreements (total and different types), dates of the events, how they came to carry this out when not authorised, if not applying why not and what is happening to the debts. There is no need to repeat information given in a validation application Your interim permission number, or if the practice previously held a Consumer Credit Licence awarded by the Office of Fair Trading, is the number that applies here. You will not be required to answer this question unless the answer to question 2.3 is as you are saying that you have undertaken activity previously without the relevant permission/ authorisation. FCA Application for Credit Authorisation SPECIMEN Limited Permissions April 2014 page 6

Page 16 About the applicant practice... continued 2 About the applicant firm Leave blank if the answer to 2.3 was No. PLEASE NOTE: If your email address has the suffix.org this is deemed misleading, as this can only be used by non-profit seeking organisations. We would recommend you use an alternative email address. 2.3.2 Does the Applicant have their own legal assessment? No Please attach a copy of the applicant s legal assessment document Attached Firm address details 2.4 Principal Place of Business of Firm Address line 1 Address line 2 Address line 3 Address line 4 Town County Postcode Country Phone number (including STD code) Fax number (including STD code) Email address Note: This email address is not copied to the email associated with user account on the GABRIEL reporting system. Users must update email details for reporting directly within the GABRIEL reporting system. Date on which this change becomes effective This is where work is primarily performed or business carried out. For a multiple-site practice this should be the main place of business. We would generally expect this to be the same as question 1.1. No need to complete this section on first application. FCA Application for Credit Authorisation SPECIMEN Limited Permissions April 2014 page 7

Page 17 About the applicant practice... continued 2 About the applicant firm Most practices are partnerships, limited companies or LLP so tick the relevant box. Further guidance is provided in Section 2 page 52 - Legal Status of the Applicant Firm. If you are unsure. please seek guidance from Medenta. About the legal status of the applicant firm 2.5 What type of firm is the Applicant? Sole trader Public limited company Private limited company Unincorporated association Partnership (other than limited partnership or limited liability partnership) Limited partnership Limited liability partnership Other UK Co incorporated by Special Act/Royal Charter Incorporated Industrial & Provident Society Act Company Limited by Guarantee with Share Company Limited by Guarantee with No Share Capital UK Body created by Special Act/Royal Charter Registered under Industrial and Provident Society Act 1965 and Credit Union Act 1979 Incorporated under Friendly Society Act 1992 Registered under Friendly Society Act 1974 Registered as an overseas company by companies house Overseas firm incorporated Overseas firm unincorporated Registered as a Northern Ireland Credit Union 2.6 What was the date of the incorporation or formation of the Applicant? (dd/mm/yyyy) / / Please supply the date on which the limited company or LLP was incorporated as listed at Companies House, for example 05/07/2010. If the practice is not incorporated, supply the date on which the practice first traded. FCA Application for Credit Authorisation SPECIMEN Limited Permissions April 2014 page 8

Page 18 About the applicant practice... continued 2 About the applicant firm If incorporated, please specify England and Wales, Scotland or Northern Ireland, as listed at Companies House. If unincorporated, answer United Kingdom. If incorporated, please supply the registration number as listed at Companies House, including the relevant prefix if registered in Scotland (SC) or Northern Ireland (NI) or OC for LLPs. 2.7 In which country was the Applicant incorporated or formed? 2.8 Companies House Registration Number Note: If your company is registered in Scotland or Northern Ireland, please include the letter prefix in front of the registration number 2.9 Registered Overseas Reference Number Note: This refers to the applicant firm s overseas company registration number if applicable 2.10 Date of the Applicant s financial year end (dd/mm) Please note that, once authorised, this date will be used to determine the date on which the firm will be required to report to the FCA / Note the change that you have requested will result in a change to your reporting timetable. I confirm the change requested above We would not expect this to be relevant for any dental practice clients. Leave blank. The date entered should be the practice s financial year end. Other address details 2.11 Registered Office Address Note: A registered office is the official address of an incorporated company. This address must be in the UK unless the Applicant Firm is a branch of an overseas company. Generally it will form part of the public record where the registered organisation or legal entity is incorporated. Please tick this box if the Registered Office is the same as the Principal Place of Business Note: Principal place of business means the main place where the work is performed or business is carried on and will appear on the Financial Conduct Authority register Address Postcode If the registered office is also the principal place of business, where work is primarily performed or business carried out, please tick the box to confirm. If the registered office is not the principal place of business please supply the registered office address as listed at Companies House. Date on which this change becomes effective FCA Application for Credit Authorisation SPECIMEN Limited Permissions April 2014 page 9

Page 19 About the applicant practice... continued If the practice has a head office, and it is the same as either or both the registered office or principal place of business, please tick the relevant box. If the head office is located at a different address, please provide details. Not relevant to UK-based firms. Leave blank. 2 About the applicant firm 2.12 Head Office Address? Please tick the box if the head office address is the same as the principal place of business Please tick this box if the head office address is the same as the registered office Address Postcode Date on which this change becomes effective 2.13 If the Applicant has a website, provide details below. If the Applicant is intending to launch a website, provide the address and launch date (if known) Please tick the box if the invoicing address is the same as the principal place of business Please tick the box if the invoicing address is the same as the registered office Website address Website launch date 2.14 If the Applicant has a UK branch address provide details below Address We would generally expect the invoicing address to be the same as the principal place of business, so tick the box to confirm this is the case. Please include details of all websites even if you do not currently offer patient finance. The regulator may review the website as part of their due diligence on your business. If you have an existing website in the launch date section insert Already live. If you are developing a website, please provide the name and an approximate launch date. Ensure the regulatory statement below is included. If your web address, has the suffix.org this is misleading, this can only be used by nonprofitseeking organisations. Postcode Date on which this change becomes effective Please tick the relevant box. There is a regulatory requirement to maintain accurate Companies House details. If you are in any doubt, please seek guidance from Medenta. Confirmation 2.15 You must confirm that all of the Applicant s relevant details match Companies House records No Give details below N/A FCA Application for Credit Authorisation SPECIMEN Limited Permissions April 2014 page 10 PLEASE NOTE: If you hold an interim permission, your website should include the statement [Practice Name] is authorised and regulated by the Financial Conduct Authority so make sure this is up to date.

Page 20 Practice contact details 2 About the applicant firm 3 Firm Contact details This will be the information previously entered in question 1.1 of this application. Firm contact details 3.1 Contact person's details for the Financial Services Register Note: We will also send an email to this person confirming that their details are to be used for this purpose. However you must confirm that they have been informed of this before submitting this application for Data Protection reasons. This individual will be displayed as the complaints contact on the Financial Services Register. If the applicant firm is a sole trader, these should be the sole trader's details. If the applicant is not a sole trader this individual must be the senior manager of the applicant firm. Please tick the box if the contact person s details are the same as the Principal Place of Business Title First names Surname Job title Address line 1 Address line 2 Address line 3 Address line 4 Town County Postcode Country Phone number Mobile number Fax number Email address FCA Application for Credit Authorisation SPECIMEN Limited Permissions April 2014 page 11

Page 21 Practice contact details 2 About the applicant firm Practices should tick the box but only once they are satisfied that the information has been fully communicated to the individual and the implications understood. 3.2 Please tick to confirm that the person named above has been informed that their details will be displayed on the Financial Services Register 3.3 Details of the auditor/ reporting accountant Firm name of auditor or reporting accountant If your accounts are audited, specify the details here. You may wish to tick the box if you intend to use a professional adviser. Do not tick if you are relying on information provided by Medenta. We would generally expect this not to be the case with larger practices. The regulator is concerned about the risks to patients who have taken out consumer credit. If this is a concern, please seek further guidance from Medenta. Date on which this change becomes effective 3.4 Details of professional adviser? Firm name of professional Date on which this change becomes effective 3.5 Please tick this box if the Applicant wants us to copy all correspondence to the professional adviser 3.6 Please tick this box if the Applicant- if it becomes authorised- plans to use a professional adviser 3.7 Pease tick this box if the Applicant is dependent on a single key person Note: If your firm is solely dependent upon one individual to run the business, you will need to have arrangements in place with another firm who has the same permissions as yourself, to assist your clients on a temporary basis due to unforeseen circumstances that might befall your firm 3.8 Locum details Firm name Firm Reference Number Firm name of adviser This relates to ongoing services, therefore Medenta details should not be included. If you have a professional adviser, include details here. If you have a locum agreement in place, please provide the details. Locum details should be provided to cover circumstances where the business is unable to continue to trade if the sole clinician becomes incapacitated for any reason. If an associate is employed and could cover in such circumstances, this should be documented as a risk and cover maintained at all time. It is for the applicant to decide if this is sufficient or if a locum is required, and details should be provided. PLEASE NOTE: If a locum is required, they must also be authorised by the FCA. FCA Application for Credit Authorisation SPECIMEN Limited Permissions April 2014 page 12

Page 22 Trading names and other names 2 About the applicant firm 4 Other Names There are regulatory controls relating to the names used by firms applying for authorisation. If you are considering making any changes to the name of the practice, please seek guidance from Medenta. Trading names and Other names If the name(s) given in 5.1 and 5.2 contain(s) a word or expression that requires the FCA s approval under the Company, Limited Liability Partnership and Business names (Sensitive Words and Expressions) Regulations 2009. We will contact you if you meet the criteria. 4.1 If the applicant intends to change the registered name, provide details below Current Firm Name New Firm name Effective Date 4.1.2 Has the change been approved on Companies House? No 4.2 If the Applicant intends to use any trading names as well as the registered name provide details below: Sole traders will always appear on the FCA Register under the name of the principal, with any other names used shown as a trading name. For example, an individual called William Bloggs, a sole trader firm, trades under the name of Bill s Cars. The name that will appear on the FCA Register will be William Bloggs, with a separate trading name entry of Bill s Cars. Trading Name(s) Effective Date If a change of registered name has been made and approved by Companies House, you may be asked for the letter of approval and/or certificate as evidence. All practices should list here any trading names they may use in any advertising or financial promotions so that the regulator is able to link the trading name to the firm. Remember, certain sensitive names need prior approval before you can use them, for example, you need GDC approval to use dentist, dental or dentistry. Further guidance is provided in Section 2 Trading Names and Other Names. FCA Application for Credit Authorisation SPECIMEN Limited Permissions April 2014 page 13 Please contact us if you are unsure or need additional assistance.

Page 23 Scope of permissions required 4 Systems and controls 5 Scope of Permission required It is the applicant firm's responsibility to ensure the scope of permission it requests will cover all the activities that it wants to do. 5.1 Limited Permission lending Note: A supplier is a person whose main business is to sell goods or supply services but does not carry on a regulated activity. For more details, please see the Guidance Notes The following regulated activities and limitations are associated with this profile: entering into regulated credit agreement as Lender (Excluding high-cost shortterm credit, bill of sale loan agreement, and home collected credit loan agreement)' The following limitation will be applied to this activity: Limited permission lending -This permission is limited to lending which the firm carries on as a supplier and (i) no charge (by way of interest or otherwise) is payable by the borrower in connection with the provision of credit under the regulated credit agreement; Practices should not generally tick any of the following - 5.1, 5.2, 5.4, 5.5, 5.6, 5.7 or 5.9. If you believe they apply, please contact us first. You may need to seek independent advice. (ii) the regulated credit agreement is not a hire-purchase agreement or a conditional sale agreement; and (iii) unless the firm is a not-for profit body, the obligation of the borrower to repay is not secured, and is not to be secured, by a legal mortgage on land And: 'Exercising or having the right to exercise lender s rights and duties under a regulated credit agreement (excluding high-cost short-term credit, bill of sale loan agreement, and home collected credit loan agreement) The following limitations will be applied to this activity: Right to limited permission lending - This permission is limited to exercising the rights and duties of loans which the firm carries on as a supplier - and (i) no charge (by way of interest or otherwise) is payable by the borrower in connection with the provision of credit under the regulated credit agreement; (ii) the regulated credit agreement is not a hire-purchase agreement or a conditional sale agreement; and (iii) unless the firm is a not-for profit body, the obligation of the borrower to repay is not secured, and is not to be secured, by a legal mortgage on land FCA Application for Credit Authorisation SPECIMEN Limited Permissions April 2014 page 14

Page 24 Scope of permissions required...continued 5.2 Consumer Hire The regulated activities associated with this profile are entering into a regulated consumer hire agreement as owner and exercising or having the right to exercise the owner s rights and duties under a regulated consumer hire agreement The following limitation will be applied to these regulated activities: Unless the firm is a not-for profit body, this permission is limited to regulated consumer hire agreements under which the obligations of borrowers are not, or are not to be, secured by a legal mortgage on land 5.3 Limited Permission credit broking Note: A domestic premises supplier is a supplier who sells goods or supplies services to customers whilst they are present in their home, for example a double glazing firm offering credit to an individual The regulated activity associated with this profile is 'Credit Broking' To offer Medenta patient finance, tick this box. The following limitation will be applied to this regulated activity: Limited to secondary broking - This permission is limited to credit broking as a supplier of goods or services (other than a domestic premises supplier) carried on the for the purposes of, or in connection with, the sale of goods or supply of services by the firm to a customer (who need not be the borrower under the credit agreement or the hirer under the consumer hire agreement) and, unless the firm is a not-for profit body, under which the obligation of the borrower to repay is not secured, and is not to be secured, by a legal mortgage on land. 5.4 Green deal broking The regulated activity associated with this profile is 'Credit Broking' The following limitation will be applied to this regulated activity: Limited to Green Deal broking - This permission is limited to credit broking in connection with Green Deal Plans as defined in section 1 of the Energy Act 2011 and, unless the firm is a not-for profit body, under which the obligation of the borrower to repay is not secured, and is not to be secured, by a legal mortgage on land 5.5 Broking vehicle consumer hire agreements The regulated activity associated with this profile is 'Credit Broking The following limitation will be applied to this regulated activity: Broking for consumer hire of a vehicle - This permission is limited to credit broking for the hire of vehicles and, unless the firm is a not-for profit body, under which the obligation of the borrower to repay is not secured, and is not to be secured, by a legal mortgage on land FCA Application for Credit Authorisation SPECIMEN Limited Permissions April 2014 page 15

Page 25 Scope of permissions required...continued 5.6 Not for Profit Debt Counselling The regulated activity associated with this profile is 'Debt-counselling' The following requirement will be applied to your Firm: "Not-for-profit firm - The firm, by virtue of its constitution or any enactment, must be: (i) required (after payment of outgoings) to apply the whole of its income and any capital it expends for charitable or public purposes, and (ii) prohibited from directly or indirectly distributing amongst its members any part of its assets (otherwise than for charitable or public purposes) And the firm must not have any associate (other than a not-for profit debt advice body) which carries on debt adjusting or debt counselling or providing credit information services. 5.7 Not for Profit and debt Adjusting The regulated activity associated with this profile is 'Debt Adjusting' The following requirement will be applied to your Firm: Not for profit firm - The firm, by virtue of its constitution or any enactment, must be: (i) required (after payment of outgoings) to apply the whole of its income and any capital it expends for charitable or public purposes, and (ii) prohibited from directly or indirectly distributing amongst its members any part of its assets (otherwise than for charitable or public purposes); And the firm must not have any associate (other than a not-for profit debt advice body) which carries on debt adjusting or debt counselling or providing credit information services. 5.8 Limited to carry on a regulated activity Under our permission regime, agreeing to carry on a regulated activity is a regulated activity in its own right. As a matter of course, a firm will carry on the regulated activity of Agreeing to carry on a regulated activity (which is limited to carrying on only the other regulated activities in its Scope of Permission Notice). The form can only agree to carry on the regulated activities specified in this Notice You must confirm that the applicant firm requests permission to carry on this regulated activity with this limitation Please tick this box, as agreeing to carry out a regulated activity is a regulated activity in its own right. FCA Application for Credit Authorisation SPECIMEN Limited Permissions April 2014 page 16

Page 26 Scope of permissions required...continued 5.9 Additional regulated activities: Debt Adjusting with the following limitation Limited to relevant credit activities - This activity is limited to relevant credit activities as defined in paragraph 2G of Schedule 6 of the Financial Services and Markets Act 2000 Debt Counselling with the following limitation Limited to relevant credit activities- This activity is limited to relevant credit activities as defined in paragraph 2G of Schedule 6 of the Financial Services and Markets Act 2000 Providing Credit Information Services with the following limitation: If you have only selected 5.3 above (Limited Permission Credit Broking) the answer to this question is No. Limited to relevant credit activities- This activity is limited to relevant credit activities as defined in paragraph 2G of Schedule 6 of the Financial Services and Markets Act 2000 Client money 5.10 Does the Applicant intend to hold client money? No Not applicable for credit broking. Leave blank. You should only select yes if you are applying for the permissions in 5.6 or 5.7 above. 5.11 Please state for the Applicant, if it holds or has held client money, the highest amount in the last calendar year, or if it did not hold client money in the previous calendar year, the highest amount of client money it projects that it will hold in the current calendar year. 5.12 Is the Applicant affiliated with one of these bodies? Citizens Advice England & Wales Citizens Advice Scotland Citizens Advice Northern Ireland Law Centres Network Advice UK Christians Against Poverty None of the above This is not relevant so tick None of the above. As the applicant is not a sole trader, tick the relevant box. Sole trader 5.11 Does the applicant employ professional staff? No Continue to Question 5.13 the applicant is not a sole trader Continue to Question 5.13 5.12 How many professional staff does the applicant employ? Leave blank. FCA Application for Credit Authorisation SPECIMEN Limited Permissions April 2014 page 17

Page 27 Scope of permissions required...continued An appointed representative is a firm or individual that carries on regulated activities under the supervision of another firm that the FCA directly authorise. This question does not generally apply to dental practices and we would expect the answer to be No. The question refers to bodies such as the Ministry of Justice, Office of Fair Trading, and Financial Services Authority (the FCA s predecessor), so is unlikely to apply unless the practice has, for example, previous experience of financial services. If you are in any doubt please seek guidance as full disclosure is required. Appointed Representatives 5.13 Does the Applicant intend to appoint an Appointed Representative? Note: An appointed representative (AR) is a person or firm who conducts regulated activities and acts as an agent for a firm directly authorised by the FCA. No 5.14 How many appointed representatives is the Applicant firm intending to appoint at the point of authorisation? 5.15 Has the Applicant ever been refused or has revoked any license, membership, authorisation, registration of permission granted by a financial services regulator government body in the UK or overseas? No Please give a full explanation of the events in question. Make sure this includes: the question number the event relates to; the date of the event; the amounts involved; the outcome; and an explanation of the circumstances If your answer exceeds 4000 characters please attach a separate document. If the answer above is No, there is no requirement to answer this question. FCA Application for Credit Authorisation SPECIMEN Limited Permissions April 2014 page 18

Page 28 Scope of permissions required...continued Please complete this as appropriate, based on the guidance provided for question 5.15. 5.16 Has the Applicant ever, after making an application to a regulatory body for: a licence; authorisation; registration; notification; membership; or other permission granted by a regulatory body? decided not to proceed with it? No Please give a full explanation of the events in question. Make sure this includes: the question number the event relates to; the date of the event; the amounts involved; the outcome; and an explanation of the circumstances If your answer exceeds 4000 characters please attach a separate document. If you are in any doubt, please seek guidance as full disclosure is required. FCA Application for Credit Authorisation SPECIMEN Limited Permissions April 2014 page 19

Page 29 Fees and levies Refer to the Fees and Levies guidance in Section 2 for how to calculate annual credit income. The figure should be a realistic estimate based on current/anticipated levels of business. The answer to this question should correspond to the answer given in question 7.2. 6 Fees and levies We require this information so that we can calculate the Applicant's annual FCA fees once authorised. We will also use this information to calculate the fees for the Money Advice Service (MAS) and the levies for the Ombudsman Service. For further help on this section please see the Guidance Notes, the fees section of the Handbook, or reer to the FCA website, which includes an approximate fee calculator (http://www.fca.org.uk/firms/being-regulated/fees/calculator) Guidance on fees is provided in Section 2 of the guide, Fees and Levies. The regulator is seeking information to clarify the amount of regulatory activity carried out by the practice and predict the potential for consumer detriment should the practice not have appropriate controls in place. Please tick the box to indicate your understanding. 6.1 Projected annual income What is the applicant firm s projected annual income from activities as applied for in the permissions sections of this application Number (GBP) Confirm amount in words Note: For Not for Profit applications - you have indicated that the applicant firm is not for profit firm so an annual fee is not applicable in this instance. Declaration of ongoing FCA fees liability 6.2 You must confirm that the Applicant understands that they are liable- and remain liable- to pay fees until such a time that the FCA cancels its permissions (this is irrespective of whether they are trading, they have notified us of intention to cease trading or they have submitted an application to cancel). You will be asked to explain your calculation after submission of your application. FCA Application for Credit Authorisation SPECIMEN Limited Permissions April 2014 page 20

Page 30 Regulatory business plan 7 Regulatory business plan Why we ask the questions in this section We need to know about the business the applicant firm intends to carry on so we can assess the scope of the authorisation it will need, the adequacy of its resources and its suitability. Further guidance on the Regulatory Business Plan is provided in Section 2 of the guide. Background You must confirm you have available a regulatory business plan. It is important that this is tailored to the applicant firms business, otherwise it may lead to delays. As a guide, the business plan should include: All firms the background to the business; why the applicant firm wishes to carry on regulated activities at this time; whether the applicant firm has identified a particular business opportunity or identified a specific customer base; any long-term strategy and expansion plans for the business generally; where customers will be sourced from (e.g. existing client base or purchase of existing book of business) including the use of any lead generators or brokers; the applicant firms plans in relation to financial promotions and communications. This should include how they will ensure these are compliant with CONC 3; current business lines being transacted with any existing clients; the types of products or credit a lender or broker offers and the types of services or debt solutions that a debt manager offers and any other services (both regulated and non-regulated) that the applicant firm will be selling. You should identify the areas that the applicant firm may specialise in; what experience the governing body or senior management of the applicant firm have of the type of regulated activities the applicant firm wishes to carry on; the background and experience of all the persons performing significant influence controlled functions and how this will help them with their role. This should include employment background. You must enclose copies of any relevant qualifications/examinations; and details of all fees that could be payable by the customer and how they are explained to the customer. FCA Application for Credit Authorisation SPECIMEN Limited Permissions April 2014 page 21