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Apply for an agency

Home

Apply for an agency

To apply for an agency please download and read the Terms of Business and complete the questions below.

Thank you for your enquiry. We will be in touch shortly.

1Company details

2Trading contact details

3Governance and declaration

Page 1 of 3 : Company details

About your company

Legal name:

Company registration number:

(If sole trader or partnership, please enter ‘0’)

FCA ref number:

Trading names:

Please enter each name on a new line

Website address:

Trading address

Address:

Page 2 of 3 : Trading contact details

Trading contact details

First name:

Surname:

Phone:

Email:

Accounts contact

First name:

Surname:

Phone:

Email:

Page 3 of 3 : Governance and declaration

Product governance - Fair Value

To help inform our fair value assessment of the product/s you place through Glemham Underwriting Ltd, we require information on the remuneration you receive and the services you provide as a part of your role within the distribution chain

As a minimum, and in accordance with PROD 4, we require information regarding:

The type and amount of remuneration you receive, including in relation to ‘add-ons’
An explanation of the services you provide as part of the distribution arrangements, and
Confirmation that any remuneration is consistent with your regulatory obligations

Your fees/charges

If your remuneration is in the form of a commission, please confirm that any additional fees would be no more than £100.

Yes

If no, please provide further information:

If you are not taking commission but are charging a fee, you are confident the fee represents fair value?

Yes

N/A

If no, please provide further information:

Premium Finance

If you offer premium finance to your customers, does this provide fair value?

Yes

N/A

If no, please provide further information:

Distribution

Please confirm that you distribute our products direct to insured only (i.e. there is no one else in the distribution chain)

Yes

If no, please explain the distribution chain:

Advised

Please confirm that the product is being sold on an Advised basis

Yes

If no, please provide further information:

Add-ons

Do you sell any ancillary products/activities alongside the product which may affect the products value?

Yes

If yes, please provide information on how these additional products affect the products value:

Declaration

I am authorised to provide the information and to make the declarations contained in this application form. It is acknowledged and consented that Glemham Underwriting Ltd may search the files of credit reference agencies and share personal details with the appropriate regulatory authorities and other insurance companies. By clicking submit, you confirm that you have read, understood and agree to the Terms of Business.

Name of authorised signatory:

Please make sure all required fields are filled

Speak to us: 01728 441 441

General enquiry

Thank you for your enquiry. We will be in touch shortly.

Name:

Email:

Telephone:

Enquiry:

Let us know how we can help

Find out more about us

Email us at [email protected]

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