Apply to become a member of the MGAA

Your Personal Details

First Name* Last name* Position* Telephone Number*

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Your Organisation Details

Organisation Name* Address Line 1* Address Line 2 Address Line 3 Town* County* Postcode* Country* Organisation Website Organisation Telephone Number* Date Established* Does your organisation have a different registered address?

Yes No

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Your Organisation Details

Registered Organisation Number* Registered Organisation VAT Organisation's Legal Status* PLC LTD LLP Name of Directors* add

• {{ director }} x

Claims Authority

Yes No

FCACBI firm authorisation* Authorised Appointed Representative FCACBI firm reference number* Who do you owe your fiduciary duty to?* Are you an Authorised Representative?

Yes No

If so, what is the name of your principal?* Are you a Lloyds cover holder?

Yes No

Do you have a binder with Lloyd's?

Yes No

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Your Organisation Details

How many producing brokers do you have?* How many policies do you write?* Average Premium Per Policy* Do you have full risk transfer?

Yes No

Do you provide ancillary products? e.g Legal Expenses

Yes No

When were you last audited?*

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GWP Section

Currency Type

GBP USD EUR

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Business Line	Insurer	No. of Years
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How many directors?* How many underwriters?* How many claims staff?* How many technical IT system related staff?* Total number of staff including Directors?* How many staff are FCII qualified?* How many staff are ACII qualified?* How many staff are DIP CII CIP qualified?* How many staff have   CERT CII APA qualifications?* How many staff are currently engaging in achieving   CII qualification? qualifications with The Insurance Institute* Are you interested in obtaining the title “Chartered Insurance Underwriting Agent” as a business?

Yes No

Are you interested in the MGAA Next Gen Group

Yes No

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Information on relevant Contacts

Email address of compliance forum contact* Email address of IT forum contact* Email address of claims forum contact* Email address of finance/operations forum contact* Email address of MGAA Lloyds market forum contact* MGAA Next Gen Group contact* Email address of Brexit forum contact Email address of training and development contact Email address of your Business Development Lead Email address of Marketing Contact Email address of Technical Underwriting forum contact*

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Business Info

What underwriting system do you use? AcceleRATE Access Acturis AppliedSystemsTAM Covernet EbixGlobal Eclipse Excel Spreadsheets Genasys Gratex Insly Instanda InsuranceEngine Magenta Majesco Mandon MarkitSystems Microsoft Novus OpenGI PhoenixAnodas PolicyStreanIWCL Quotemac RDTLandscape Sabrefish Schemeserve SSP Transactor Websure Xuber Own Bespoke Other

• {{ system }} x

Are you an InsurTech business (are you innovating with the use of technology)?

Yes No

If not, do you aspire to become one in the next five years?

Yes No

How often do you update your TOBA?*

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Professional Indemnity Insurance

Do you buy your professional indemnity insurance as part of a group

Yes No

Please advise which broker you use* Please advise which insurer you use* What limit is on your policy?*

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Supplier info

Please describe the bespoke products and/or services you wish to promote to the MGAA membership.* How do your Organisation's products and/or services specifically benefit MGAs?* Name the MGAs you are currently working with.* List three highlights of your product and/or services that differentiates you from others in the marketplace.* Identify any preferred or discounted services you would be willing to offer MGAA members.* How do you envisage engaging with the MGAA and it’s Members?*

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Market Practitioner information

Please can you provide your S&P/AM Best rating. Organisation's legal status (eg Ltd, LLP etc)* FCACBI firm reference number* How many years have you been involved in MGA Delegated Authority business?* Are you able to provide an introduction to any MGAs who are not in membership?

Yes No

If yes, who?* How do you envisage engaging with the MGAA and it’s Members? Please provide the number of MGAs currently supported by you. What covers do you provide capacity for? What is the minimum annual premium to be considered for any one arrangement? What is your future involvement in the MGA sector? What can the MGAA do to help support your MGA/Delegated Binding Authority related strategic goals? Are you willing to participate or facilitate future activities organised by the MGAA?

Yes No

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Billing Info

Is your billing address different to your company address?

Yes No

Payment Method Select a Payment Method Monthly - Direct Debit Annually - BAC's Annually - Card Payment Method Select a Payment Method Annually - BAC's Annually - Card Sort Code Account Number Are two or more people required to approve the direct debits?

Yes No

Additional Comments?

Any additional comments?

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