Affiliate Application Form

We wish to become an affiliate of MPI Brokers in order to sign post customers to the MPI Brokers Travel Insurance Plans.

As an Affiliate the applicant becomes an agent of MPI Brokers and an unregulated introducer which will not require any licence or permissions from the Financial Conduct Authority (FCA). Should your business activities now or at any time in the future exceed the introducer status you must immediately inform MPI Brokers and please also read the section in Terms of Business relating to regulations.

  • Please complete all sections below. Where there is an option of YES or NO please place a tick in the relevant box.
  • Where GN appears in the box please refer to the guidance notes below the form.
  • * indicates a required field
  • You will be asked to accept our Terms of Business which you can find further down this page
  • If there is insufficient space, or an answer needs further explanation, please use the Additional Information area at the end of the form.

16. I have read and accept the Guidance Notes, Sales & Promotions and Terms of Business.

If an affiliation is offered, I accept on behalf of the Applicant the Terms of Business.

Guidance Notes

GN1: In order for us to be in a position to give advice on the insurance we provide for your customers please give
a full description of your firm’s activities

GN2: If you tick two or more of the boxes in Q8 your firm falls under the Package Travel Regulations and we will
be in contact to discuss regulatory matters

GN3: If you or your firm falls under the Package Travel Regulations there is a requirement to protect customers’ deposits.

Sales & Promotions

As part of the MPI Affiliate programme we request that agents actively promote MPI to their customers onan exclusive basis and we have shown below some marketing ideas:

Travel Companies:

  1. insert the MPI suggested text (to be provided) in your T’s & C’s, this helps to protect your company’s liability and attracts more sales
  2. prominently display insurance buttons [with hyperlinks] on your website and brochures
  3. mention insurance in any holiday quotes and refer to your T’s & C’s
  4. refer to insurance on your Booking Confirmation [with hyperlinks] or the accompanying email and your T’s & C’s
  5. links in newsletters and any other social media
  6. insert sales flyers in posted documents (if any) e.g. flight tickets
  7. mention insurance at the end of holiday sales calls.

For travel companies that fall under the Package Travel Regulations the process explained in 1–4 above is a requirement – (signposting under the PTR).

Clubs, Associations, Retail Shops, Ski-Slopes, Journals and others:

  1. prominently display insurance buttons [with hyperlinks] on your website and brochures
  2. actively promote insurance to members (clubs and associations)
  3. prominently display and distribute sales material in a customer environment, e.g. at the till (shops and ski-slopes)
  4. links in newsletters and any other social media.

Terms of Business

  1. Introduction

    MPI Brokers ('MPI') is a trading name of Michael Pettifer Insurance Brokers Ltd who is incorporated in England and Wales under company number 4469885 and is authorised and regulated by the Financial Conduct Authority and whose registered address is Greens Court, West Street, Midhurst, West Sussex, GU29 9NW. MPI's correspondence address is West House, West Street, Haslemere, Surrey, GU27 2AB.

    For the purpose of these Terms of Business the Applicant shown in Box 1 becomes an Unregulated Introducer and an Agent of MPI Brokers. The term Affiliate shall mean Agent.

  2. Regulation

    The Affiliate must comply with the rules of the statues of Unregulated introducer which limits the insurance activities to that as an introducer only.

    The Affiliate may not give advice on this or any other insurance, make any recommendations, arrange insurance or collect premiums but effect only an introduction to MPI Brokers.

    The FCA defines an Introducer as a tied agent or affiliate who carries out effecting introductions or distributing non-real time promotions.

  3. Obligations

    1. The Affiliate shall use all reasonable endeavours to introduce customers to MPI in accordance with the Sales and Promotions notes on page 4 of the Affiliate Application form, and comply with the obligations set out.

    2. MPI will deal directly with customers of the Affiliate and where possible offer them insurance that they may reasonably request and advise the customer of the premium and any fees applicable

      Create and maintain a database of records relating to insurance sold. Credit commission to the Affiliate's commission account and make payments as requested from time to time. The Affiliate may not invoice MPI for commission

  4. Commission

    Upon the introduction of a customer, commission shall be earned by the Affiliate in perpetuity upon the sale of insurance at the rate agreed from time to time and shall be calculated on the Gross Premium

    Gross Premium is the total amount paid less any service charges and insurance premium tax

  5. Premiums

    We hold the right to change premiums at any time without notice.

  6. Exclusivity

    The Affiliate shall not market or promote any other insurance plan

  7. Intellectual Property

    Both parties will retain ownership of all their respective rights, including intellectual property rights in their respective plans, databases, computer programmes, documents, materials, ideas or other information which shall include claims statistics

  8. Termination

    Either party may give three months written notice to the other to terminate the agreement. The effect of termination shall be that the Affiliate shall lose any future commission on business from introduced customers after termination

  9. Confidentiality

    Neither party shall disclose to any third party any confidential information disclosed to either of them by the other nor use this for their own benefit which shall include but not limited to all information which relates to the operations, plans, know-how, trade-secrets, business affairs, logos, trademarks and intellectual property of either party

  10. Expenses

    Each party shall be responsible for its own expenses incurred in performing its obligations under these terms of business

  11. No Partnership

    Nothing in these Terms of Business shall be construed as constituting a partnership between the parties

  12. Value Added Tax

    Should there be a liability to VAT on the commission earned by the Introducer; this shall be the responsibility of the Introducer. In the event that Her Majesty's Customs and Revenue (HMRC) deem MPI, the underwriting agent or Insurers responsible for VAT on the Introducer's commission, we and they hold the right to recover such sums paid from the Affiliate

  13. Liability

    The Affiliate shall indemnify and keep indemnified MPI for any errors or omissions caused by the Affiliate

  14. Law, Jurisdiction and Regulation

    These terms of business are governed by the laws of the United Kingdom and the parties submit to the exclusive jurisdiction of the various courts of the United Kingdom and the Affiliate shall at all times comply with the rules laid down by the Financial Conduct Authority.


MPI Brokers Head Office
West House, 19-21 West Street
Haslemere, Surrey, GU27 2AB
United Kingdom

Contact Us
For corporate calls - 01428 664265

Copyright © 2002- MPI Brokers.
All rights reserved.


Michael Pettifier Insurance Brokers Ltd. trading as MPI Brokers, Mind The Gap Year, MPI Don’t Stop Me Now and Douglas Cox Tyrie is authorised and regulated by the Financial Conduct Authority FCA number 308481