Promotion code (if applicable)  
Business Details  
Contact Name *  
Trading name of firm to be insured *  
Trading address *  
District  
Town *  
County *  
Post code *  
Date firm established * (dd/mm/yyyy)  
What is your status with the NACFB? *  
Please provide your membership number: *  
Contact email address *  
Telephone *  
Mobile  
Fax
 
Website  
Do you require cover for any previous trading names? *
Yes  No
   
If yes, please give details below:
Name of firm  Date established
 
 
   
Please declare the number of staff within the firm
  
How many Directors/Principals/Partners *  
How many Sales consultants *  
How many Administration staff *    
   
Are you directly authorised by the FSA? *
Yes  No
If yes, please provide your FSA number