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Application for Terms of Business

Brokerage Contact Details

*Required Fields

Principal Contact Details

Brokerage Consultant

Complete for all consultants that require a sub-account for commission calculation and application inputpurposes, including Principal if appropriate. Please enclose/upload Identification and Proof of Residential Address for all individuals named, as well as the applicant. We will not be able to accept business without this.

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Supporting Documents

Allowed file types are docs, pdf, xls. Max file size 5MB. Files that will not meet requirements will not be uploaded.

Please accept this as my application for Terms of Business with Life Administration Services Limited ("LAS").

I confirm that all the information contained herein is true and accurate, and I undertake to inform LAS should any of this information change in the future.