Prerequisites


Agency Details


















Main Contact Details

(Title/Forename/Surname)


All business critical information will be sent to this email address.

Broker Online Profile





Additional Contact Details

About Your Business

Commercial:
Personal:
Annual Premium Income:

Appointed Representative Additional Information

Section 1 - About Your Appointed Representatives:




Section 2 - Governance and Compliance:



Please provide further details


Please provide further details


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Section 3 - Please confirm that you have written agreements in place with all your ARs that cover the following:



Please provide further details


Please provide further details


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Open GI
SSP
Durrell
Acturis
Other


Please provide further information


Coversure
Cobra
Bluefin
Willis
Broker Network
Other


Please provide further information



Please provide further information


Please provide the name of your iprism contact

Tradesman, Contractors & Professionals
Commercial Combined
High Value Home
Contractors Combined
Residential Property Owners
Commercial Property Owners
Retailers
Restaurants, Wine Bars & Public Houses
Hotels, B&Bs & Guest Houses
Office
Surgery
Internet Traders
Teachers & Tutors
Professional Indemnity
Directors & Officers
Stand Alone Terrorism

Principal’s Details





Please provide full details below

Professional Indemnity Insurance





Bank Details



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Declaration

Terms & Conditions

The iprism Terms of Business Agreement (TOBA) is based on these Terms & Conditions

You must read and agree to our Terms & Conditons.