Millennium Insurance :: noticeably different

Business Partner Online Application, Step 1 of 4

Appointed Representatives:

If you are an Appointed Representative/member of a Network, you must apply via your normal network Principal contact for access to this Trading Centre first, not directly to Millennium. If in doubt telephone us on 01952 28 2007.

General Details About You

Main Contact Name

Main Contact Telephone

Company Compliance Officer Name (if different to above)

Your Trading name/Brand name

Full Registered Company Name (if Different from above)

Company Registered Office and Registration No

Full Postal Address

Telephone Number

Facsimile Number

E-mail Address

Directors/ Principals and Approved Persons responsible for General Insurance

	Name	Position	Qualifications /experience	IMD *)
1
2
3

IMD *) Responsible for Insurance Mediation under FSA

Background and Trading History

Have you or any Director/Partner/ Senior Manager listed ever been subject to an adverse finding, offence, conviction, or legal proceedings/ CCJ whether past or pending

Yes
No

About your regulated business activities