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You introduce, we do all the work (research, sales, admin, compliance, renewals and claims)
You receive 33% of the initial commission.

Introducing Firm
Fsa Number
Advisor Name:
Email Address:

Network or Support Services Provider
Contact Address
Comments
Select your commission share for this lead
33% of year 1 only 25% each year
(please remember renewal commission for most cases equals
just 5% therefore your share is usually 1.25% of annual premium)
 
The following is/are interested in Private Medical Insurance for:
Single Couple Family Corporate Group
Client 1 Name: DoB:
Client 2 Name: DoB:
Contact Address
 
Tel:
Email:
Does the Client have an existing Medical Insurance Policy?
YES NO
 
PMI PARTNERS/Assured Futures is committed to ensuring the privacy of our clients and other people that we have dealings with. In our Privacy Policy we explain how we hold, process and retain your personal data.

Please confirm your consent to process your data, that you have accepted our Terms of Business and Privacy Policy and that you have your clients consent to pass us their contact details
   

pmi partners
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PMI Partners is a trading style of Assured Futures Limited. Authorised and regulated by the Financial Conduct Authority.
Registered address Ellenborough House, Wellington Street, Cheltenham, Glos, GL50 1AP No.3040737. Calls may be recorded.
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