1. Company details Company name (including trading name, if applicable) * Company status (partnership, limited company, charity etc) * Registered office address line 1 * Address line 2 Address line 3 Town/city * County * Postcode * Country/region * Company registration number * VAT number (if applicable) Principal named contact * Job title * Contact email * Contact number * Website address * 2. Company information List all Company Directors * List (or attach) any/all associated entities in the group, such as sister companies, parent or holding companies (as applicable) * NB: Not just UK companies Or attach a file listing associated entities Choose a file… Files must be less than 2 MB.Allowed file types: gif jpg jpeg png. Are any relevant persons e.g. Directors, relatives, or former employees connected with or do they have any associations with UCAS or UCAS Media? * Yes No If yes, give details * Has the Company had previous dealings with UCAS or UCAS Media? * Yes No If yes, give details * Do any key individuals at the Customer hold public office or are politically exposed? * Yes No If yes, give details * Is the Company (or any third party on whose behalf it is acting) regulated by the Financial Conduct Authority or Prudential Regulatory Authority / does the Company operate in financial services regulated industry or perform financial services regulated activity? * Yes No e.g. banking, lending, insurance If yes, give details, including FCA reference number * Is the Customer (or any third party who it may be acting for) regulated by any other body? * Yes No e.g. Food Standards Agency, Advertising Standards Agency, Health and Safety Executive If yes, give details * 3. Financial information Does the Company have any dealings in any sanctioned countries? * Yes No e.g. Cuba, Syria, Crimea, Iran, Venezuela, North Korea If yes, give details * Will the entity that UCAS Media invoices be UK based? * Yes No If no, give details * Will payments be made in £GBP? * Yes No If no, give details * Does the Company expect to be charged VAT? * Yes No Accounts department contact name * Accounts department phone number * Email address (for invoices and statements) * Address for invoices and statements (if different from trading address) Do you use a Purchase Order system? * Yes No UCAS Media uses a third-party credit reference agency for credit assessment purposes. In the event that any credit account is opened, you are hereby providing us with your consent to carry out any credit reference searches that we deem necessary. These searches will be taken for credit information purposes only and may be carried out on both your Company and its Principals. The credit reference agency may also keep a record of our enquiry and share that information with other businesses that may also make enquiries about the Company and its Principals. This does not affect your statutory rights. UCAS Media invoices are due for payment 30 days from the date of the invoice, unless otherwise stated. UCAS Media Ltd reserves the right to apply interest to any invoice not paid as per the agreed terms. This is according to our statutory right under the Late Payment of Commercial Debts Regulations 2013. 4. Legal compliance Have any claims been made, or are any claims pending, against your Company in the last three years? * Yes No If yes, give details * Has your organisation ever been prosecuted or is it currently subject to any proceedings under Criminal Finances Act and/or Health & Safety legislation? * Yes No If yes, give details * Under the Modern Slavery Act 2015, are you a relevant commercial organisation and if so, are you compliant with the annual reporting requirements? * Yes No If no, give details * Answer the following two questions in relation to each of the offences listed below: Bribery, corruption, and fraud Competition prohibitions Money laundering or terrorist offences Child labour and other forms of human trafficking Financial and economic sanctions Any breaches of environmental, social or employment law obligations Bankruptcy or material professional misconduct NB For clarification on any statement in this section, please contact your Account Manager. Has your Company, or any Directors / partners / other persons who have powers of representation, decision, or control, been convicted of any of the offences listed? * Yes No If yes, give details * Has the Company made any disclosures to the appropriate bodies in the last 5 years or been investigated regarding an alleged or suspected breach of laws? * Yes No If yes, give details * Does the Company have policies and procedures in place in relation to compliance offences, such as anti-bribery and corruption risks (including facilitation payments), and to report any potential breaches of anti-bribery laws, as well as wider social reputational risk factors such as environmental and diversity and inclusion? * Yes No If yes, please provide supporting documentation * Choose a file… Files must be less than 2 MB.Allowed file types: gif jpg jpeg png. Or provide relevant links to such documentation * Has the Company (or any third party on whose behalf it may be acting) operated in any countries with high corruption scores as set out in the Corruption Perception Index? * Yes No If yes, give details * 5. Declaration To the best of my knowledge, all information set out in this application is correct and complete and I confirm that I am duly authorised by the Company to sign this Declaration. We understand that UCAS Media will rely on the information disclosed in this form and any other means of communication in determining whether to enter into any agreement (including standard terms and conditions) or any other form of arrangement with us. We agree to report any significant changes to the information provided as soon as reasonably practicable of any such changes or instances occurring. I wish to open a credit account with UCAS Media Ltd. I am authorised by my Company to do so. Signed on behalf of [Company Name] * Name * Job title * Date * Leave this field blank CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
