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