(Open 9am-5pm Mon - Fri)
If you are interested in becoming a Congregational agent for Congregational policies, please complete the form below. Once submitted a member of the agency department will contact you.
My legal title differs from the above*
My trading address differs from the above*
Type of company*
How did you hear about us?*
Are there any associated companies?*
Is your company a subsidiary company?*
Is your company a shareholding company?*
Please provide the following details relating to your EDI functionality*
Does your company transact business through aggregator sites?*
Do you utilise risk transfer?*
Do you work on an advised sales basis?*
Does your company provide sub broking facilities for intermediaries other than appointed representatives?*
Does your company have any appointed representatives?*
Is your company a member of any intermediary networks?*
What proportion of your company’s premium income relates to the following classes?*
Does your company operate any niche schemes?*
Please provide the following details of your company’s professional indemnity & certificate*
Do you have FCA permission to hold client money?*
Do you withdraw commission on settlement of insurers account*
Do you hold consumer credit permissions?*
In respect of any Director’s, Partner’s, Principal’s, Appointed Representative’s or members of staff, please confirm they have not:
a. been subject to disciplinary proceedings from the FCA, ICO or other regulatory body
b. been the subject of liquidation / bankruptcy procedures?
c. been the subject of a receiving or administration order?
d. made a deed of agreement with creditors?
e. been a director of a company wound up under the companies act?
f. been convicted of any criminal offence, other than a motoring offence, not treated as spent under the rehabilitation of offenders act 1974?
g. been the subject of a County Court Judgement?
h. had credit refused or withdrawn?
i. traded as an insurance intermediary under another name
Has an agency previously been held with Congregational Insurance Solutions Ltd??*
Has any agency ever been cancelled other than for lack of support?*