Delegated authority questionnaire

Delegated authority qualification questionnaire

Please fill out the below form with as much information as possible. Nothing in this form shall be legally binding on either party and nothing herein shall obligate Zurich or you to proceed with any transaction or provision of services contemplated between us. Each party reserves the right, in its sole discretion, to terminate any discussions contemplated by this form.

*indicates compulsory field

Name

Broker or MGA name

Role in your organisation

Phone number

Email address (professional)

Overview of the scheme/MGA and reason for marketing

Size of the opportunity (GWP and expected customer volumes)

Proposed go live date

Intended target market for the scheme

Lines of business and covers required

Distribution model (retail or wholesale) and remuneration expectations

Overview of performance

By submitting this form, you agree that the information provided, is to the best of your knowledge, complete and accurate. You agree to promptly notify us if there is a material change to any of the information you provided.

Once you have submitted this form, your details will be passed to a member of the delegated authority development team who will be in touch shortly.

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