Tenet Lime Broker Registration

Please download, read and confirm your acceptance of the FSA Agreement between you and Select & Protect.

You will need the Adobe Acrobat Free Viewer Program. If you do not have it installed, you can obtain a copy by clicking here:

   *I have read and accept the Agreement and confirm I have the necessary authority to enter into this Agreement.

Your details:

Company name: Address Postcode

Your full name: Your position: Telephone: Mobile: E-mail: FSA number:

Choose your SynerGI Trading System password (please note that this is case sensitive)

Broker information:

Where did you hear of Select & Protect?	Tenet LIME Network Sourcing system Colleague referral Select & protect representative Website advert Magazine advert Website search Direct mail in the post E-mail Seminar/Conference/Expo
Which other General Insurance providers do you use?
How many mortgages do you complete in a month?
How many Home Insurance policies do you complete in a month?
How many MPPI policies do you complete in a month?
Which mortgage sourcing system(s) do you use?

Other users:

Which other staff will be using us?

1 Name		Position		Telephone
2 Name		Position		Telephone
3 Name		Position		Telephone
4 Name		Position		Telephone

Commission Payment Details

In order for us to pay commission into your account we will need to take some pertinent details. All data will be sent over a secure server and a SSL Certificated webpage

Bank name		Account number
Bank account name		Sort code

Thank you for registering.

Please submit your completed application form by clicking on the Send button, we will then contact you shortly with your Broker Reference.