New Business Submission Sheet - ASSURED PROTECT - INSURANCE

Please ensure that all of the relevant supporting documents have been obtained from your Client (see Product Matrices to check required items) and that all files have been uploaded to the appropriate workflow accordingly. All fields with an * must be completed before clicking the 'submit' button below.

NOTE - To save a copy of this NBSS for your own record, before clicking the Submit button below, click "CTRL + P" and save this page as a PDF document

Please leave blank:

SUBMISSION DETAILS

Your name (name of Assured Protect authorised Broker):

Date application submitted to the Insurance Company:

Is this Client Introduced? (PLEASE SELECT):

No Yes

If 'Yes', please confirm the name of the Introducer. If 'No', please type NONE in this field:

CLIENT DETAILS

Client Name(s):

Face to Face, or Remote transaction (PLEASE SELECT):

Face to Face Remote

PROVIDER DETAILS

Insurance Company Name:

PRODUCT DETAILS

PRODUCT TYPE:

Total Monthly (or Annual) Premium at Application (please state pm, or pa):

IF GI / RGI - Full address, including post code, of property to be insured. OR 1ST LINE OF CORRESPONDENCE ADDRESS FOR PERSONAL OR BUSINESS PROTECTION:

REMUNERATION DETAILS

EXPECTED GROSS COMMISSION:

PLEASE PROVIDE ANY ADDITIONAL INFORMATION HERE

SUPPORTING NOTES:

UPLOAD 1 - You can upload documents here (max file size 3mb):

UPLOAD 2 - You can upload documents here (max file size 3mb):

Please confirm:

I have obtained all required and mandatory documents for this application, as detailed in the relevant Product Matrix and all documents have been uploaded to the appropriate compliance workflow.

NOTE - To save a copy of this NBSS for your own record before clicking the Submit button below, click "CTRL + P" and save this page as a PDF document.

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Your home may be repossessed if you do not keep up repayments on your mortgage.

We normally charge a Professional Client Fee for mortgage advice. The amount will depend on your circumstances. A typical fee would be £500. The actual Professional Fee may be more or less than this, and is subject to a full Fact Find discussion and research process. H D Consultants is a trading name of Howard Reuben who is an Appointed Representative of PRIMIS Mortgage Network, which is a trading name of Personal Touch Financial Services Ltd. Personal Touch Financial Services Ltd is authorised and regulated by the Financial Conduct Authority. This site is for UK Consumers only. Website Terms and Conditions click here for our Privacy Policy. GDPR Privacy Policy - click here (PDF download / view) This site contains third party links. By clicking these links you will depart from the H D Consultants' regulated site. H D Consultants nor PRIMIS Mortgage Network is responsible for the accuracy of the information contained within the linked site. The Financial Conduct Authority does not regulate some of the services listed. H D Consultants, mortgage and life insurance advisers, is authorised by the FCA no 403701. Our in house Wills and Trusts Practice is a long standing Member of the Society of Will Writers and Estate Planning Practitioners.

FP Ref: 1436009 / exp 25.08.2025

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