Agency Initial Enquiry Form

Important:

Please be aware that the information you provide below will be considered as part of your application and as such Allianz may use the personal details you give us or supplied by third parties to assess your agency request with us. We may search the files of Credit Reference Agencies and Fraud Agencies, who may keep a record of the search.

Where key information is found to be incorrect (e.g. your FCA number) or unsatisfactory the enquiry will not be followed up.

Allianz UK does not trade with Irish general insurance agencies, however we will accept applications for engineering inspection business. If you’re wishing to place general insurance with Allianz please contact Allianz Ireland directly.

Please note that fields marked with asterisk (*) are mandatory.

Enquiry details
Contact details
Broker/agency details
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Financial Conduct Authority number You must provide us with your official FCA number as found on the Financial Services Register. If you trade from the Channel Islands or Northern Ireland, please use your identification code associated to your financial regulatory body.
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Financial Conduct Authority number You must provide us with your official FCA number as found on the Financial Services Register. If you trade from the Channel Islands or Northern Ireland, please use your identification code associated to your financial regulatory body.
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imarket registration Our preferred method of handling Statement of accounts is internet based. If you’re not already registered, please register with imarket and confirm your number as soon as possible.
Current trading

Current £GWP controlled - Please provide details of the size of book, broken by product line by GWP:

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If you do not have a book for this, please just insert 0
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If you do not have a book for this, please just insert 0
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If you do not have a book for this, please just insert 0
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If you do not have a book for this, please just insert 0
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If you do not have a book for this, please just insert 0
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If you do not have a book for this, please just insert 0

Please provide the details of size of book broken down by product line by number:

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If you do not have a book for this, please just insert 0
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If you do not have a book for this, please just insert 0
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If you do not have a book for this, please just insert 0

  

  

  

  

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Websites If you use any website(s), please detail the website address (URL) in the text box below.