Insured Nomads - Terms of Business Agreement

Terms of Business Agreement

Brokerage: Terms of Business Agreement/Application

1. Company details

Company Name/Full Trading Name*

Complete this field with your Company Name

Address Line 1*

Address Line 2

City*

State / Province*

ZIP / Postal Code*

Country*

Primary Contact (First Name)*

Primary Contact (Last/Surname)*

Primary Email*

Phone*

Work Phone

Website*

2. Nature of Business

Nature of Business/Specialties

3. Firm Status & Background

Are you a registered insurance broker/producer?*

Yes

Registration Number

Date of Registration

Registration/license number

Do you have E&O/professional indemnity cover?*

Yes

E&O/Professional Indemnity Certificate

4. Criminal Convictions & Bankruptcy

Have you ever been convicted of a criminal offense?*

Yes

If yes, give details:

5. Company Contacts

Commission Payment Contact Person:*

Email address:*

Sales Contact

Name*

Email:*

Account Management Lead Contact

Name:*

Email:*

6. Volume Estimation

Health insurance: estimated volume of cross-border/globally distributed team health plans (GWP) with us in the next 12 months.

Travel insurance: estimated volume of travel insurance plans (GWP) with us in the next 12 months:

7. Declaration

Title/Position held:*

Date signed:*

Thank you for choosing Insured Nomads as your partner in the evolution of insurance for the revolution of travel.

A team member will reach out to you to discuss the scope of the partnership, including general terms, renumeration, obligations, and more.

Insured Nomads Corporation © 2025
The evolution of insurance for the revolution of travel.
USA: 120 19th St. N. Ste. 401 Birmingham, AL 35203 | NPN: 19616300
France: 60 Rue François 1er 75008, Paris
UK: 63/66 Hatton Garden, 5th Floor, Ste 23, EC1 N 9LE, London
Ireland: 13 Adelaide Road, D02 P950, Dublin