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Introducer Options
Life Assurance
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Equity Release
Introducer Options - General Insurance
 

General Insurance Introducer Commission
Renewable up to 10% of the Annual Premium

       
INPORTANT NOTICE: Please ensure that a ‘Client Referral Authorisation’ form has been signed by the client to confirm they agree to be contacted by Premier Network Group.
       
Download a Client Referral Authorisation Form here
Not a PNG member? Please register here
       
Introducer details:      
       
First Name*: Surname*:
Company Name*: Members ID*:
(If not a member of PNG, you will need to register, click here)
 
Client Details:      
       
Single
       
Client Name*: Client Surname*:
Client Home Tel: Client Mobile*:
Preferred Time to Call*:    
       
Date of Birth*: Smoker:
       
Client Current Address*    
     
     
     
Post Code*:    
       
Client New Address:    
     
     
     
Post Code*:    
 
Quotation for*:
If Other, Please Specify:
 
Additional Information:
 
 
  * mandatory fields