Notification of amendment to, or termination of, a senior appointment

Please use this form to notify Lloyd's, prior to FSA confirmation, of a proposed amendment to, or termination of, the role of an individual appointed to a senior position.

All fields are mandatory. Where a field does not apply please enter N/A.


Notification of amendment to, or termination of, a senior appointment
Name of underwriting agent
Title
First name
Middle name / Initial
Last name
Job title
Effective date of change / termination
Reason for change / termination
Individual is still at the firm :-
Individual's role has changed and their 'Approved Persons' authorisation will change (Give reasons below)
Individual's role has changed and will no longer be appointed to a relevant senior position
Individual has left the firm :-
Individual has resigned
Individual has been made redundant
Individual has retired
Individual's fixed-term contract has expired
Individual has been dismissed
Is this individual a Managing Agent's Trustee of the Lloyd's Premium Trust Deed (a 'PTF Trustee')?
Yes
No
If 'yes', please summarise any other changes to the PTF trustees
Is this individual a director of any Corporate member(s) owned by the group?
If 'Yes' please list the membership number of the member(s) and confirm whether the advised change applies to this/these appointments
Detailed explanation of change / termination (where required)
Contact details of person completing the form
Name
Job title
Email address
Telephone
Last updated on 19 Jan 2010