Planet Earth Travel Insurance  

Agent Registration

Company Details

  Title First Name Surname
Contact Details
Contact position
Postcode
Company name
Trading name
Address



Telephone number
Fax Number
Email address
(Note: Confirmation of your agency application will be emailed to this address)
Retype email Address
Website Address
Type of company
Number of staff
Year established

Professional Indemnity Insurance details

If available, please provide details of your professional indemnity insurance policy
Insurer
Policy no.

Username and Password

1. We suggest you use your business name for the username
2. Maximum 30 characters long
3. You can use letters and numbers but avoid characters such as (& ' % ")
Username
Password
Retype password

Keeping you informed

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Terms & Conditions

Click here to view and print the Planet Earth Agency Terms and Conditions (PDF)
I have read and agree to the Planet Earth Agency Terms and Conditions
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  Planet Earth Travel Insurance Services Ltd is authorised and regulated by the Financial Conduct Authority. Our Financial Services Register Number is 705878. | © Planet Earth Travel Insurance Services Ltd SecurityMetrics for PCI Compliance, QSA, IDS, Penetration Testing, Forensics, and Vulnerability Assessment
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