Apply for Membership

Full Name (required)

Registered Company Name (required)

Company Address (required)

Landline Number (required)

Mobile Number (required)

Main Email (required)

Website

Other Email Addresses (employees/staff)

Tick the relevant services you provide:

General Insurance
MotorHouseholdTravelHealthLegal Expenses

Commercial Insurance

Life
PensionsInvestmentsProtectionMortgages

Tick your authorisation status:
AuthorizedPending

Optional: Please tick Authorisations
IDRIIACCACMCARMIFID

Payment Option: (Please tick prefferred payment option)
Yearly FeeDDEFTCredit CardMonthly (€110)1st14th

Additional Information / Requests