Join - For Insurers

Please submit your full details to join. If you have any issues with the form you can write to us on ipmi(at)ipmimagazine.com - replace AT with @. This page is secured and encrypted using SSL. All fields must be filled out. We do not share, sell or distribute any reader or advertiser data unless you specifically ask us to introduce you to that person. In those instances you have full control of data provided.
Title(*)
Invalid Input

First Name(*)
Please type your full name.

Last Name(*)
Invalid Input

Your Job Title(*)
Invalid Input

Company Name(*)
Invalid Input

Your Address(*)
Invalid Input

E-mail(*)
Invalid email address.

Office Phone No.(*)
Invalid Input

Mobile Phone No.(*)
Invalid Input

Web site(*)
Invalid Input

What does your company do?(*)
Invalid Input

Talk Us Through Where You Do Business(*)
Invalid Input

Which types of industry do you do business with? (*)
Invalid Input

Who Do you do business with?(*)
Invalid Input

How much iPMI business do you currently write P/A?(*)
Invalid Input

How much PMI business do you currently write P/A?(*)
Invalid Input

What lines of insurance do you provide?(*)
Invalid Input

What % of business written by you personally is fee based?(*)
Invalid Input

What % of business written by you personally is commission based?(*)
Invalid Input

What is your personal annual commission/fee income relating to IPMI business?(*)
Invalid Input

What is your personal annual commission/fee income relating to PMI business?(*)
Invalid Input

Gross Written Premiums for iPMI in 2015(*)
Invalid Input

Gross Written Premiums for PMI in 2015(*)
Invalid Input

What % of business written is for group IPMI?(*)
Invalid Input

What % of business written is for group PMI?(*)
Invalid Input

What % of business written is for individual PMI?(*)
Invalid Input

What % of business written is for individual iPMI?(*)
Invalid Input

What % of business written is for Expats?(*)
Invalid Input

What % of business written is for Business travelers??(*)
Invalid Input

What % of business written is for Leisure travelers?(*)
Invalid Input

Insert The Characters(*)
Insert The Characters
Invalid Input

×

Log in

fb iconLog in with Facebook