SUPPLIER APPLIcAtIon foRM - MGAA

www.mgaa.co.uk
SUPPLIER
Application
forM

SUPPLIER
Application form
All responses will be kept strictly confidential for the benefit of the MGAA only
Organisation Name:
Mailing Address:
Postcode:
Telephone Number:
Website Address:
Contact Person
Name:
Title:
Telephone Number:
Email Address:
General Information about the suppliers product and/or services:
Please describe the
products and/or service
you wish to promote within
the MGAA membership:
How does your Company’s
product and/or service
specifically benefit UK MGAs
List 3 highlights of your
product and/or service that
differentiates itself from others
in the marketplace
www.mgaa.co.uk

SUPPLIER
Application form
List 3 MGAs for whom you have provided your product or service
Company 01
Company Name:
Telephone Number:
Product/Service:
Contact Person:
Email:
Company 02
Company Name:
Telephone Number:
Product/Service:
Contact Person:
Email:
Company 03
Company Name:
Telephone Number:
Product/Service:
Contact Person:
Email:
What preferred or discounted
services would you be willing
to offer MGAA members:
Please provide a br ief
description of your product
and/or service that is suitable
for inclusion on the MGAA
members web pages
How many MGA clients do
you currently have
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SUPPLIER
Application form
What are the top three benefits you
would expect to derive from your
first full year of membership
(Note: Your response will serve as
the basis of an annul interview/
assessment with the MGAA leadership)
I understand that the application must be favourably considered by the membership committee before the applicant
can participate in the association. The application fee of £5,000 representing a joining fee of £1,500 and the first year’s
membership fee of £3,500 should accompany this document.
Please can you send your application form and cheque to the MGAA, IUA, London Underwriting Centre, 3 Minster Court,
Mincing Lane, London EC3R 7DD. Cheques should be made payable to Managing General Agents’ Association. Payment can
also be made by bacs to:-
Coutts & Co
440 Strand, London, WC2R 0QS
Reference: MGAA fees
Account Name: Managing General Agents Association Limited
Account Number: 04254554
Sort Code: 18 -00 -02
IBAN: 32COUT18000204254554
Supplier will be invoiced on the first anniversary date for a renewal fee of £3,500 and annually thereafter at a fee to
be determined by the MGAA Executive Committee.
Acceptance of membership certifies
1) Qualification for active membership as set forth in the articles and by-laws;
2) that the undersigned will abide by the MGAA articles and by-laws as they may be amended from time to time; and
3) that the undersigned is not aware of any reason why the letter and spirit of the association by-laws cannot be
strictly observed.
Name:
Date:
Signature:
Declaration:
Please do not complete this section if the organisation is already regulated by the FSA or is a member of any recognised
professional body.
Has the organisation or any Director, Partner, Proprietor:
1. been involved in liquidation, receivership, bankruptcy, dissolved, high court writ, voluntary winding, been struck off or
similar procedure pending or been subject to receiving order or County Court Judgment
2. been convicted of any criminal offence (not treated as a spent conviction under the Rehabilitation of Offenders Act 1974)
other than motoring convictions
If the answer to any of the above questions is “Yes” please give full details on a separate sheet.
Name:
Date:
Signature:
Declaration:
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