Registration
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*
are required.
Contact name
*
Position
*
Contact Tel:
*
Contact email:
*
Company Name
*
Address
*
Town / City
*
County
*
Postcode
*
Company Reg No
.
If applicable
Company Tel:
Company Website
Commission income:
£
Premium Income
£
No. of Clients
Premises type:
Freehold
Leasehold
Portfolio only
Your company business split:
Commercial %
Personal
%
Life / Financial %
Specialist %
Main Agencies where business is currently placed
Composites %
Lloyds %
Your current broker system:
Please Select.....
Policy Master
Misys
CSC
MCS
Cheshire Data
NMT
Web based ASP
Paper Office
Other
Please list any special schemes, segments or relationships of interest
Do you have other Agents ?
*
Yes
No
Additional information e.g. Buyers you do not wish to talk to.
.
©Insuretec Ltd, Elm Tree Farm, Rose, Truro. TR4 9QJ
Registered at Companies House England Reg. No. 3462686 VAT Reg. No. 714 5058 51 VAT Reg. No. 714 5058 51