STOP! Please check cover start date before proceeding.


Our Broker Portal is no longer live for requested cover start date of 1st March 2017 or later. Please contact Sam Thompson on 01892 786085 or Robert Tuke on 01892 786083 or email brokers@coastinsurance.co.uk

Broker Signup

In order to use this website, you must first be registered as an agent of Park Home Insurance Services Ltd. Please note that we can only consider applications from brokers who are directly regulated by the FCA, and who have a current agency agreement with our main underwriter, Zurich Insurance plc. If you have any queries concerning signup, please call us on 01892 786059.

Trading Details



Registered address of the Business





 

Full trading address of the Business






 









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Please provide details of your professional indemnity cover




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Please give details of the principals/partners/directors


Principal Details






 


Please give the name and address of your accountants.






 


Please give the name and address of the your auditors.









Name three insurance companies with whom you hold credit agencies in order that we may obtain a reference.


Insurance Company Name
 

Branch


Agency Number



Please Give the name of your Bankers







 




 


 

Park Home Insurance Services Limited may from time to time consult credit reference agencies and these agencies may record details of such searches. Any information obtained will be used to assess your financial standing and to make decisions regarding your application and the subsequent conduct of your account. By submitting this signup request you consent to Park Home Insurance Services Limited making searches of your records for such purposes (including, where applicable, sensitive personal data) from the date hereof until the termination of the agency appointment, which ever is the later.