Our products View our range of products to find out more. Farm & Agriculture Insurance cover backed by Aviva for farm, rural, and agricultural businesses. Environmental Impairment Liability Cover for costs resulting from a pollution incident due to your clients' business activities. Professional Indemnity Cover for damages and costs in relation to claims for alleged professional negligence or incorrect advice. 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 an agency Apply for agency Close 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: Enter address manually Find address Autocomplete 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 Previous Continue Submit