Company Details
Current Agencies
Business Details

Please provide a split in your premium income between:

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Declaration
Has any Director, Partner, Proprietor or Manager personally or by association:

We hereby make application to become an agent of Moorhouse Xbroker.

We declare that the information given in this application is accurate and complete and we agree that this application is the basis for the working relationship between ourselves and Moorhouse Xbroker.

We understand that in the event that any of the information contained in this application is not complete or accurate then our Terms of Business Agreement may be terminated by Moorhouse Xbroker at its sole discretion.

By submitting this application we hereby consent to Moorhouse Xbroker conducting a credit check on the Applicant and/or any of the persons named.

Documents

Please note that the application requires the following documents before it can be processed. To save time, we will accept them in electronic format attached to this application. Can you attach the following:

If you cannot send the above documents electronically then please forward them without delay to:

Agency Department,
Moorhouse Xbroker,
Barclay House,
2-3 Sir Alfred Owen Way,
Caerphilly,
CF83 3HU