Policy Authority Mandate

Complete this form to grant NorthStar access to your policy information

(Can’t sign online? Download a Policy Authority Mandate for each policy, complete them and post back to us.)

Authority

I hereby advise that NorthStar Wealth Management Group Ltd is appointed as my authorised financial planner with immediate effect.

Checkboxes

Information only. Please provide my financial planner with any information they require in relation to this policy. This may include valuations, policy details, copies of correspondence, personal information and any other information they request.

Full servicing rights. Please transfer the full serving rights of this policy to my financial planner including any adviser charges, commission or other fees. Please also provide my financial planner with any information they require in relation to this policy. This may include valuations, policy details, copies of correspondence, personal information and any other information they request.

Policyholder Details

Full Name

Previous Name (if applicable)

Date of Birth

National Insurance Number

Address

Previous Address (if less than 3 years at current address)

Policy Details

Company

Policy Number

Company

Policy Number

Company

Policy Number

Company

Policy Number

Company

Policy Number

Company

Policy Number

Financial Planner Details

Company

FCA Number

Telephone

Address

Ocean Village Innovation Centre
Ocean Way
Southampton
Hampshire
SO14 3JZ

Additional Notes (if applicable)

Signature

This authority shall remain in place until such time as I cancel it.

Please sign below using your mouse or touch-enabled device:

Signature

Clear

Checkboxes

I am signing on behalf of a minor (under the age of 18). I am the parent, guardian or other legal representative and confirm I am authorised to act on their behalf.

First Name

Last Name

Date

If you are human, leave this field blank.

Awards, Accreditations & Trade Associations

NorthStar is proud to be a member of the leading financial planning trade associations. Through a continued commitment to adhere to the highest professional standards and deliver exceptional service, NorthStar has received a number of awards and professional accreditations.

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