Cosmetic Insurance Affiliate Scheme

Full Trading Title*
Address Line 1*
Address Line 2*
Town*
County*
Post Code*
Email Address*
Website Address
Trading Style*
- Sole Trader
- Partnership
- Private / PLC
Company Registration Numbner*
Nature of Business*
Date Business Established*
Have you ever had an agency (insurer or intermediary) cancelled or refused?*
Are any insurance activities outsourced to third parties? If so, please provide full details.*
Do you have any Sub-Agents or third parties who introduce business to you in respect of the classes of business to which this application relates?*
In respect of general insurance, are you currently, or do you intend to be, acting as an appointed agent, appointed sub-agent or introducer for any other insurer or intermediary? If so, please provide full details of such arrangements.*
Are you authorised by the FCA?*
- Yes
- No
If yes state Authorisation Number
If ‘NO’ do you intend to become authorised? (Please state intentions)