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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
 
Please confirm you have read and agreed to the terms & conditions
   

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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