Become a Caledon Broker

Company name including Trading Names/Styles *

Telephone number (Main Office) *

Website *

Address (Main Office) *

Registered company number *

Date business established *

FCA Firm reference number *

Main line of business *

Are you a member of any groups, networks or associations?

Are you registered with www.reg.uk.com? *

Yes

If No, please provide the email address of the TOBA signatory

Please tell us what interests you about partnering with Caledon

Is registered address the same as the main office? *

Yes

Registered office address

Number of staff *

Number of offices *

Other office locations

Insurer *

Limit of Indemnity *

Excess *

Date of expiry *

Have you submitted any Professional Indemnity Insurance claims in the last 12 months? *

Yes

Please give details of any Professional Indemnity Insurance claims you've made in the last 12 months

Approximate annual Household & Contents Written Premiums (£) *

Which other providers do you use to place your non-standard home business with?

Director Text

Please complete the details about your company Directors / Principal(s).

Please list the Name, DOB, Nationality & Country of Residence of all Directors *

Have you or any Company Directors, Principals, Partners or Managers ever had an Agency terminated or had an application to enter an Agency Agreement/TOBA refused or declined? *

Yes

Have you or any of the Company Directors, Principals, Partners or Managers, or any other organisation in which you or they have held a Managerial/Directorship position ever been, or is aware of any circumstances, which may result in being subject to disciplnary proceedings instituted by any professional or regulatory body? *

Yes

Have you or any of the Company Directors, Principals, Partners or Managers, or any other organisation in which you or they have held a Managerial/Directorship position ever been involved in liquidation, receivership or bankruptcy, received a County Court judgement, an administration order or entered into an arrangement with creditrors or is any matter pending? *

Yes

Have you or any of the Company Directors, Principals, Partners or Managers ever been convicted or charged with (but not yet tried for) a criminal offence other than a motoring offence, involving a non-custodial sentence? *

Yes

Contact Text

Please complete the information on these important contacts in your company to help us with onboarding.

Main contact name *

Main contact position / title *

Main contact telephone *

Main contact email *

Accounts contact name *

Accounts contact position / title *

Accounts contact telephone *

Accounts contact email *

Use this email to send account statements to *

Yes

Account Statements contact name

Account Statements contact position / title

Account Statements contact telephone

Account Statements contact email

Personal Lines Manager/Household Manager Contact *

Personal Lines Manager/Household Manager contact position / title *

Personal Lines Manager/Household Manager contact telephone *

Personal Lines Manager/Household Manager contact email *

Access Text

Please complete the details of anyone else who needs system access in the following format (one person per line): Firstname Surname, name@email.com, Job Title

Access Personnel *

Additional Text

Please provide us with this additional company information to provide us with insight on how we may be able to help you in the future.

Are there any products or particular areas of the insurance market that you specialise in? *

Are there gaps in your product range that you're keen to fill? *

Please share the main sources of your new business enquiries. *

Authorise *

I/We Submit this application for the appointment of intermediary facilities with Caledon MGA. and authorise Caledon MGA to contact any individual or entity whose name has been provided in the application for the purpose of verifying the accuracy of the information and the applicants' suitablilty for appointment.

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Let's get the ball rolling

Broker Application form