Proposal Forms

Please fill out the form below, and we will be in touch as soon as possible.

To help inform our fair value assessment of the product/s you place through Elmlake MGA Limited, we require information on the remuneration you receive and the services you provide as a part of your role within the distribution chain

As a minimum, and in accordance with PROD 4, we require information regarding:

• The type and amount of remuneration you receive, including in relation to 'add-ons'
• An explanation of the services you provide as part of the distribution arrangements, and
• Confirmation that any remuneration is consistent with your regulatory obligations

I am authorised to provide the information and to make the declarations contained in this application form. It is acknowledged and consented that Elmlake MGA Limited may search the files of credit reference agencies and share personal details with the appropriate regulatory authorities and other insurance companies. By signing the application, you confirm that you have read, understood and agree to the Terms of Business.

Please fill out the form below, and we will be in touch as soon as possible.