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Status Global Insurance Affiliate Application
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If you are interested in becoming a Status Global Insurance affiliate, please complete the following application:
Name of Organisation:
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Please select the products you are interested in being an affiliate for:
EHIC in France
European Health Cash Plan
Expat Health Insurance
Primary Business Activities:
How long have you been in business?
If you have been in business less than 2 years, please provide information about previous experience:
Are you regulated under any statutory Or Professional Body?
If you answered 'yes' to the above question, please provide details:
Do you have Professional Indemnity Insurance?
If you answered 'yes' to the the above question, please provide the name of your insurance company, policy number, and date of policy expiration:
Have you ever had an agency terminated or declined?
If you answered 'yes' to the above question, please give details:
Please give the name of two other Agencies that you hold:
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