New broker enquiry

If you are interested in becoming an Integra agent for Congregational policies, please complete the form below. Once submitted a member of the agency department will contact you.

Thank you for your enquiry.

A member of the agency team will contact you within 2 working days to discuss your enquiry, if you have any queries in the meantime please call us on 01274 700 830.

Company name*
Address line 1*
Address line 2*
Address line 3*
Address line 4
Your name*
Job title*
Name of contact (If different from above)
Job title of church insurance contact (If different from above)
Telephone number*
Email address*
Web address
Financial Services Register Number*
Do you have permission to hold client money?*
FCA legal title
Quote system used* (if no system state none)
EDI capable?
If you belong to a network, please give details
If you are a member of any professional bodies please give details
Total premium income
General account premium income
Church business premium income
Delegated authority / affinity group schemes
If yes please give details
Do you conduct business or intend to conduct business through subagents?
If yes please give details
How did you hear about us?