PROSPECTIVE MEMBER

If you are an authorised insurer, self insured or compensator and interested in becoming a subscriber to CUE, please complete the form below.

1. Full Name of Organisation


2. Registered Address





3. Correspondence Address



4. Contact Person

a. Name

b. Telephone No.

c. Email Address




5. Data Processor - Have you already had discussions with a data processor and have therefore made a choice about your supplier?

 

If Yes then please indicate your choices:

a. CUE Home

b. CUE Motors

c. CUE Personal Injury




6. Delegated Authority - Do you have any delegated authorities who:

a. Make enquires on your behalf for:

i. CUE Home

ii. CUE Motor

iii. CUE Personal Injury

b. Process claims on your behalf for:

i. CUE Home

ii. CUE Motor

iii. CUE Personal Injury



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Insurance Database Services Ltd
1st Floor, 100 Fenchurch Street, London EC3M 5JD
Tel. No.: 020 7265 5766    Fax No.: 01524 736136    E-Mail: idsl@polarisplus.co.uk