Application for authorisation
To be completed by MoJ
Name of applicant
waqar ali mahmood
Important information you should read before completing this form
NOTE: Guidance is available on the on-line version of this form
We require all applicants to complete this form as part of their application for authorisation. Please keep a copy of the form you complete for future reference.
For the purposes of complying with the Data Protection Act, please note that any personal information provided to us will be used to discharge our statutory functions under the Compensation Act 2006 and other relevant legislation and may be disclosed to third parties for those purposes.
You must read and ensure that you comply with the Rules of Conduct before you begin filling in this form. It is important that you provide accurate and complete information and disclose all relevant information. If you do not, you may be committing an offence, it may increase the time taken to assess your application and may call into question your suitability to be authorised.
Terms used in this form
In this form the MoJ uses the following terms:
“MoJ”, “we”, “our” or “us” to refer to the Ministry of Justice.
“Applicant” refers to the business or individual applying for authorisation.
“You” refers to the person(s) signing the form on behalf of the applicant (see the “Declaration” for further details). Purpose of this form
We will authorise an applicant only if we are satisfied the authorisation conditions are met. The information in this form is required to enable us to assess whether the applicant satisfies the conditions.
Contents of this form
Contact details for this application
About the applicant
Companies House registration information
Additional locations and business activities
Individuals involved in the business
9 – 15
Sectors and turnover
16 – 17
Relationships with others
18 – 20
General compliance and marketing
Claims Management Regulation – Application for authorisation (04.12)
Filling in the form
1. If you use 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 the completed form and sign the declaration, and
when you complete the form it will be submitted electronically; however you must still sign and post the form to us.
2. If you fill in the form by hand:
use black ink,
write clearly, and
sign the declaration.
3. If you think a question is not relevant to you, write “not applicable” and explain why.
4. If you leave a question blank or do not sign the declaration 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 form, you may need to use separate sheets of paper. Clearly mark each separate sheet of paper with the relevant question number.
6. Post this form, any additional sheets of paper, evidential documentation and the application fee of
£950 to us at:
Claims Management Regulation
Monitoring and Compliance Unit
57 - 60 High Street
Burton on Trent
7. The Authorisations team can also be contacted on 0333 200 1321, by fax on 0845 450 6866 or by email at; firstname.lastname@example.org Your application form and fee MUST be accompanied by evidence of identification and proof of residential address for the individuals signing the declaration at Section 10.
The evidence required includes;
copy photo-identification e.g. photo driving licence or passport; and
2 utility bills dated within the last 6 months e.g. gas, electricity, water, council tax or