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New Agency Enquiry

If you are interested in becoming an agent for Congregational please complete the form below. Once submitted a member of the Agency Department will contact you.

*Compulsory field
Company Name *
Company Address *
Postcode *
Name of Contact *
Position *
Name of Household Contact (if different from above)
Title of Household Contact (if different from above)
Telephone Number *
Email *
Web Address:
FSA Authorisation Number *
FSA Legal Title:
How did you hear about us? *
Quote System Used * if no system used state none
EDI Capable?	YesNo
If you are a member of any professional bodies please give details
Total Premium Income
General Account
Approx percentage split of premium income	Church Home	% %
Delegated AuthorityIAffinity Group Schemes? *	Yes No
If yes give details
If you conduct business or intend to conduct business through sub-agents please give details

Congregational & General Insurance plc is authorised and regulated by the Financial Services Authority, authorisation number 202089.