Apply Online | Jardine Lloyd Thompson

1. Contact Details

Name of company:
Name of agent:*

Address:*
Address 2:
Town/City:*
County:
Post code:*

Email address*:
Telephone:*
Mobile:
Fax:

Date firm established?*
Date license obtained:*
The date you wish cover to start:*

2. Please Provide...

A. Income earned in the last completed financial year in respect of introducing players to clubs with a view to negotiating or renegotiating an employment contract:* (Please enter whole pounds only)	£

B. The number of players contracted to you for whom services as described in question 2A above have been performed in the last completed financial year:*

C. The number of players contracted to a third party for whom services as described in question 2A above have been performed in the last completed financial year:*

3. Please Confirm the Following:

A. Do any of your clients have a contract that differs in any way from the FIFA Standard Representation Contract?*	Yes No

B. Has FIFA membership of any Principal and/or the proposer ever been suspended, withdrawn or amended?*	Yes No

C. Have any claims have been made against the proposer or predecessor in the business?*	Yes No

D. Is the Proposer aware of any claim or claim circumstance which is likely to give rise to a notification on the policy?*	Yes No

4. Premium Selector

Total number of players:

Cover:

CHF 670k

CHF 340k

CHF 100k

Premium:

JLT will provide you with a total cost upon receiving your submission.

Premium:

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Please activate JavaScript and refresh the page, or complete the form and JLT will contact you.

Please select which level of cover you are interested in: *

Note: Limits are in Swiss Francs (CHF) as FIFA regulations require licensed agents to have a minimum of CHF 100,000 of Professional Indemnity insurance cover.

5. Terms & Conditions

I declare and acknowledge:

that I am, after enquiry, authorised by all person or entities seeking insurance, to make this proposal;
that after enquiry, all information supplied in this proposal and any supporting documents attached to this proposal or supplied separately, is true and correct and that until a contract of insurance is entered into, I am obliged to inform the appropriate Underwriters of any changes to any information supplied or of any new information that is relevant;
that I understand the appropriate Underwriters rely on the accuracy of the information and documentation supplied proposing for this insurance;
that if a contract of insurance is entered into, all information and documentation supplied in proposing for this insurance shall be incorporated into and form part of such contract of insurance;
that I understand that no insurance is in force until a contract of insurance is entered into, which is upon the proposers' acceptance of an offer by the appropriate Underwriters, if any.

Please enter your initials into the box to confirm that you acknowledge and agree to the terms and conditions above:*

Apply Online - Licensed Football Agents

Complete the application form below to receive a written quotation from Jardine Lloyd Thompson Limited.

1. Contact Details

2. Please Provide...

3. Please Confirm the Following:

4. Premium Selector

5. Terms & Conditions

JLT Contact Details

Football Agents Insurance

FAQs