Welcome PageAdvice to Churches LinkIntermediary Support LinkAbout CongregationalClaims and Policies

Agency Enquiry

If you are interested in becoming an agent for Congregational please complete the form below. Once submitted a member of the Agency Department will contact you.

Agency Enquiry Form

* Compulsory field

Name of contact *
Position *
Name of household contact
Title of household contact
Company Name *
Company Address *

Postcode *
Telephone Number *
Email *
Web Address
FSA Authorisation No *
How did you hear about us? *
Quote System Used *
If no system used state none
EDI Capable?

If you are a member of any professional bodies please give details


Total Premium Income
General Account

Approx percentage split of premium income
church %
home %

Delegated Authority/Affinity Group Schemes? *

If yes give details

If you conduct business or intend to conduct business through sub-agents please give details