Broker & Agency Application Form

Great news that your firm is interested in applying to be a broker or agent for Azur Underwriting Limited (“we”/“our”/“us”).

To comply with our legal obligations, including in relation to Anti-Money Laundering and Counter-Terrorist Finance regulations we require certain information from you. We use this information in order to conduct checks and verify data about your firm and key officers. The checks include:

  • A credit report on the firm;
  • An identity check to confirm the identity of each company director or partner;
  • Sanctions and PEP (Politically Exposed Persons) checks on all directors, shareholders and principals.

We use a company called CreditSafe to perform the above checks and by submitting the application you agree that we may do so.

Certain insurer(s) for whom we act as an agent may also wish to perform additional checks as part of their own regulatory obligations. You agree that we may share with them the information that you provide for this purpose.

Information provided by you will be treated as confidential and shall be handled in accordance with our Privacy Policy.

Thank you for registering your interest!

We will get back to you via email within 24-48 hours.

Broker & Agency Application Form

To apply, you must complete the application below on behalf of your firm. Please note that the application cannot be saved across devices, and therefore we recommend collecting all the necessary information prior to completing the application and providing the consent below.

Name of Azur Business Development Manager who recommended that your firm establish a broker or agency relationship?

Whoops! There are some errors or omissions in your details below. Please update your details and try again.

    Your details

    Firm details

    About your business

    Professional indemnity insurance

    Limit of indemnity

    Please confirm that this cover meets current regulatory requirements

    Delegated underwriting authority

    Controllers

    Please provide details of all >10% shareholders

    Contact details

    Underwriting key contact details

    Accounts key contact details

    Compliance key contact details

    Declaration

      Had any agency or similar facility declined, terminated or granted on special terms with any insurer?
      Been subject to disciplinary proceedings instituted by any professional or regulatory body?
      Been convicted of any criminal offence other than minor motoring offences, not regarded as spent under the Rehabilitation of Offenders Act 1974 or comparable legislation?
      Been subject to a CCJ, declared bankrupt, or held a management position in a business that has been involved in liquidation, receivership, bankruptcy, a voluntary wind up order, or any similar procedure pending?

    ! Please confirm that you understand and agree to the checks set out above by ticking the relevant check boxes and clicking “Submit Application”.