Please complete this form as comprehensively as possible to assist us with assessing your application efficiently. All questions must be answered. If not applicable or relevant, please enter “N/A”. Once complete please hit submit.
Do you hold any relevant memberships/subscriptions?
Do you provide any specialist schemes within the Insurance Market?
Do you place business provided by or on behalf of any sub agents/sub brokers/introducing brokers?
Please note the application is subject to the Company, Director
and/or owner of the applying brokerage having not been:
In consideration of Corin Underwriting Ltd assessing our application, we, the applicant, confirm that after conducting reasonable enquiries, the information in this application form is accurate and complete to the best of our knowledge and belief. We acknowledge that if we have provided any false or misleading information in connection with this application, it may lead to the rejection of the application.
We also confirm that the information provided is true, accurate and up to date as at the time of the application. We will notify Corin Underwriting Ltd if there are any changes in the information given in this application form before the application is approved.
70 Gracechurch StreetLondon EC3V 0HR+44 (0)20 3968 firstname.lastname@example.org
Copyright © 2022. All rights reserved
Corin Underwriting Limited. Company No. 10149990
Regulated by the Financial Conduct Authority FRN No. 746269
Designed by TurnbullRipley