Last Site Update:
15/03/2010
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Apply To Become A
GI
Secure Agent
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Apply To Become A
GI
Secure Agent
To start selling GISecure’s general insurance products, please complete the below form and we will register you as an agent. Full log in details will be provided to you.
Contact Name
Position
Full Trading Name
Full Postal Address
If the company operates a network please provide number of:
Independent Authorised Members:
Authorised Representatives:
Business:
Mortgage Broker
Independent Financial Adviser
Contact Details
Telephone
Fax
Email
Company Registration No
Financial Services Act Authorisation No:
Insurance Commission
Income for your current financial year:
Number of Staff:
Name and e-mail address of required users
Name
Email
1.
2.
3.
4.
5.
Number of Required Users:
Professional Indemnity Cover Details
Insurer
Limit of Indemnity:
Excess Applicable:
Renewal Date:
How long has the Company dealt with General
Insurance products?
Which General Insurance products does the Company distribute?
Mortgage Payment Protection:
Household:
Other Payment Protection Insurance:
Other:
Which Insurers do the Company currently use?
Which Trade Association do you belong to, if any?
