Brokers Welcome - Northern1 International Insurance Brokers OU

Broker company's full legal name(Required)

Broker company registration number(Required)

Broker company website(Required)

Broker company registered address(Required)

Broker company business address if different

Broker company's ultimate beneficial owners including, parent, subsidiaries and associates(Required)

Broker company's principal contact person and position(Required)

Principal contact person's email address and telephone number(Required)

Regulation status(Required)

In what country broker company is regulated as insurance broker(Required)

Broker company's insurance license number (if different from registraton number)

What is the website of financial authority where broker company is regulated:(Required)

Broker company's professional indemnity (PI) insurer(Required)

Broker company's PI policy is valid from(Required)

Broker company's PI policy is valid to(Required)

Broker company's PI level of cover (limit per claim and in the aggregate)(Required)

Broker company's PI policy deductible/excess per claim

Insurance classes of business that broker company is interested to cooperate with Northern1(Required)

Descrption of broker company's distribution channels (corporate; private, affinity lines etc.) and in what countries(Required)

Other additional and relevant information

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