PMI Partners

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

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 is a division of Assured Futures Limited. Authorised and regulated by the Financial Services Authority.
Registered address 133 Promenade, Cheltenham, Glos, GL50 1AP No.3040737. Calls may be recorded.