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Product Governance - Fair Value Assessments / Target Market Statements

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Product Governance - Fair Value Assessments / Target Market Statements

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Our products

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1Company details

2Trading contact details

3Governance and declaration

Page 1 of 3 : Company details

About your company

Legal name:

Company registration number:

(If sole trader or partnership, please enter ‘0’)

FCA ref number:

Trading names:

Please enter each name on a new line

Website address:

Trading address

Address:

Page 2 of 3 : Trading contact details

Trading contact details

First name:

Surname:

Phone:

Email:

Accounts contact

First name:

Surname:

Phone:

Email:

Page 3 of 3 : Governance and declaration

Product governance - Fair Value

To help inform our fair value assessment of the product/s you place through Glemham Underwriting Ltd, we require information on the remuneration you receive and the services you provide as a part of your role within the distribution chain

As a minimum, and in accordance with PROD 4, we require information regarding:

The type and amount of remuneration you receive, including in relation to ‘add-ons’
An explanation of the services you provide as part of the distribution arrangements, and
Confirmation that any remuneration is consistent with your regulatory obligations

Your fees/charges

If your remuneration is in the form of a commission, please confirm that any additional fees would be no more than £100.

Yes

No

If no, please provide further information:

If you are not taking commission but are charging a fee, you are confident the fee represents fair value?

Yes

No

N/A

If no, please provide further information:

Premium Finance

If you offer premium finance to your customers, does this provide fair value?

Yes

No

N/A

If no, please provide further information:

Distribution

Please confirm that you distribute our products direct to insured only (i.e. there is no one else in the distribution chain)

Yes

No

If no, please explain the distribution chain:

Advised

Please confirm that the product is being sold on an Advised basis

Yes

No

If no, please provide further information:

Add-ons

Do you sell any ancillary products/activities alongside the product which may affect the products value?

Yes

No

If yes, please provide information on how these additional products affect the products value:

Declaration

I am authorised to provide the information and to make the declarations contained in this application form. It is acknowledged and consented that Glemham Underwriting Ltd may search the files of credit reference agencies and share personal details with the appropriate regulatory authorities and other insurance companies. By clicking submit, you confirm that you have read, understood and agree to the Terms of Business.
Following submission, Glemham will complete appropriate due diligence checks, after which policies can be bound.

Name of authorised signatory:

Please make sure all required fields are filled

Our products

View our range of products to find out more.

Lavender farm

Farm & Agriculture

Insurance cover backed by Aviva for farm, rural, and agricultural businesses.

Water testing environmental impairment liability

Environmental Impairment Liability

Cover for costs resulting from a pollution incident due to your clients' business activities.

People in an office

Professional Indemnity

Cover for damages and costs in relation to claims for alleged professional negligence or incorrect advice.

Office workspace

Commercial

Commercial insurance designed to assist in mitigating the impact of losses which occur during your client's normal business activities.

Short-Stay Accommodation Insurance

Cover for property owners renting out furnished accommodation for short stay.

Looking for some friendly expert advice?

Get in touch with our team.

Speak to us: 01728 441 441

Apply for agency

Thank you for your enquiry. We will be in touch shortly.

1Company details

2Trading contact details

3Governance and declaration

Page 1 of 3 : Company details

About your company

Legal name:

Company registration number:

(If sole trader or partnership, please enter ‘0’)

FCA ref number:

Trading names:

Please enter each name on a new line

Website address:

Trading address

Address:

Page 2 of 3 : Trading contact details

Trading contact details

First name:

Surname:

Phone:

Email:

Accounts contact

First name:

Surname:

Phone:

Email:

Page 3 of 3 : Governance and declaration

Product governance - Fair Value

To help inform our fair value assessment of the product/s you place through Glemham Underwriting Ltd, we require information on the remuneration you receive and the services you provide as a part of your role within the distribution chain

As a minimum, and in accordance with PROD 4, we require information regarding:

The type and amount of remuneration you receive, including in relation to ‘add-ons’
An explanation of the services you provide as part of the distribution arrangements, and
Confirmation that any remuneration is consistent with your regulatory obligations

Your fees/charges

If your remuneration is in the form of a commission, please confirm that any additional fees would be no more than £100.

Yes

No

If no, please provide further information:

If you are not taking commission but are charging a fee, you are confident the fee represents fair value?

Yes

No

N/A

If no, please provide further information:

Premium Finance

If you offer premium finance to your customers, does this provide fair value?

Yes

No

N/A

If no, please provide further information:

Distribution

Please confirm that you distribute our products direct to insured only (i.e. there is no one else in the distribution chain)

Yes

No

If no, please explain the distribution chain:

Advised

Please confirm that the product is being sold on an Advised basis

Yes

No

If no, please provide further information:

Add-ons

Do you sell any ancillary products/activities alongside the product which may affect the products value?

Yes

No

If yes, please provide information on how these additional products affect the products value:

Declaration

I am authorised to provide the information and to make the declarations contained in this application form. It is acknowledged and consented that Glemham Underwriting Ltd may search the files of credit reference agencies and share personal details with the appropriate regulatory authorities and other insurance companies. By clicking submit, you confirm that you have read, understood and agree to the Terms of Business.
Following submission, Glemham will complete appropriate due diligence checks, after which policies can be bound.

Name of authorised signatory:

Please make sure all required fields are filled

Speak to us: 01728 441 441

Apply for an agency

Find out more about us

Email us at [email protected]

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