Agency Application Form

  • Agency Application Form

    Apply to become an approved agency with Mission Underwriters. Please complete all sections and provide accurate information.

  • General Information

  • Do you have any additional offices to be covered by this TOBA?*
  • Format: +44 0000000000.

  • Directors' Details

  • Regulatory and Attestation Questions

  • Has your firm ever been refused agency facilities?*
  • Has your firm or any director/partner ever been convicted of a criminal offence (other than minor traffic offences)?*
  • Has your firm or any director/partner ever been subject to any regulatory application, investigation, or disciplinary action?*
  • Has any director/partner previously held directorship or partnership in a firm that has failed or become insolvent?*
  • Is your firm or any director/partner currently involved in any other insurance-related business?*
  • Has your firm or any director/partner ever been found liable for negligence, fraud, or dishonesty?*
  • Has your firm or any director/partner ever been subject to an order under insolvency or similar legislation?*

  • Product and Business Information

  • Document and Permission Status

  • Does your firm hold current Professional Indemnity insurance?*
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  • Is your firm authorised to hold Client Money?*
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  • Mission MGAs

  • Which of our MGAs are you applying to trade with:*

  • Billing Contact Details

  • Compliance Policies and Procedures

  • Does your firm have policies and procedures for bribery, corruption, sanctions, and financial crime?*
  • Does your firm have policies and procedures for Consumer Duty and Vulnerable Customers?*
  • Does your firm have policies and procedures for Complaints and Conduct Risk?*

  • Declaration

  • Declaration Date*
     - -
  • Should be Empty: