We want to work with you!

But before we can, we need to know more about you.

Please complete this form and provide all additional documentation as advised.

Please note that by completing and submitting this form, you are consenting to us storing and processing the information provided. The information will be stored as long as it is required or relevant. Upon expiration of its relevance, it will be destroyed.

Agency Application Form

Business Addresses

Contact Details

Email Addresses

Full Names and ID numbers of Directors

Do you have professional indemnity cover?

Provide the name of any other short term insurance companies -

Are you a VAT Vendor?

If you are a VAT Vendor, we require your VAT number and a copy of your VAT certificate.

Are you a member of any broking or insurance association?

Accreditiation

Please upload the following additional documents that we require.

Please also download, complete, commission and re-upload the following affidavit document.

Thank you for applying! We will consider your application and get back to you as soon as possible.