Financial Intermediary Registration Form

Account Information
Spaces are allowed; punctuation is not allowed except for periods, hyphens, and underscores.
A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.
Choose a password that contains at least six characters that should include numbers, punctuation and upper and lowercase letters. This will be used with your username for your unique 3XD login.
Provide a password for the new account in both fields.
About Your Company
You can set a default amount of commission sacrifice unique to your user record. Please select a whole amount from 0% to 30%. This can be amended within a quotation on a case by case basis.
Personal Information
Additional Services From 3XD
3XD can email the statement of demands and needs as part of the document pack for you to print on your own company letterhead.
Banking Details
Initial indemnity is 12 months commission in advance following receipt of the first premium. Monthly commission is paid every month upon receipt of the customers first premium.
Enter the characters shown in the image.