Confirmation of proposed change of control

This form should be completed to confirm to Lloyd's that a proposed change of control has been approved by the FSA.



Confirmation of proposed change of control
Name of underwriting agent
Name of controller(s) being replaced
Name of new controller(s)
Date of FSA approval
Contact details of person completing the form
Name
Job title
Email address
Telephone
Last updated on 09 May 2008