Online Application Form

To apply for your general insurance agency, please complete the form below.

Your data is protected by secure SSL encryption.

Intermediary Application

General Insurance

Click here to view our Terms Of Business Agreement – VERSION – 3rd May 2018.

Before submitting your application, you must read and agree to our Terms of Business Agreement.

Please print a copy for your records.

This form must only be completed by those firms who are directly authorised by the Financial Conduct Authority (FCA).

The person completing the form must be a Director (Limited Companies) or Principal / Partner and defined and registered as such on the FCA register. We will email confirmation of your agency number to the email address on the FCA register (or by post if there is no email address) once your application for a general insurance agency has been formally approved.

* Required

1. Agency Details

Important: This application form is only for use by directly authorised sole-traders.

Appointed Representative has the meaning given to it in section 39(2) of the FSMA (including any person making sales or representations on behalf of any Appointed Representative).

If yes, please contact us at ifasupport.gi@landg.com for additional information prior to completing this application form.

Please be aware that any of the following permissions granted by the FCA, must relate to non-investment insurance contracts and apply to retail customers:

It is also an important requirement that the firm has the ability to conduct General Insurance mediation activity.

Please provide a general description of the firm’s business trading model:-

2. Contact Details

Full registered business address

3. Data Protection

Please note that the following categories are required: