Application for admission as a pure address broker

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Characteristics of the applicant

Salutation

Name of the address broker

First

Last

Date of birth

Address

Address Line 1

City

State / Province / Region

E-mail

Priority phone number

Nationality

Account holder name

First

Last

IBAN number for compensation payments

Account holder address

Address Line 1

City

State / Province / Region

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I (we) confirm the following points as a declaration on my (our) honor

I (we) undertake only to clarify with potential customers whether they are interested in concluding an insurance contract or in receiving advice and not to provide any insurance or pension advice.
I (we) undertake not to take any legal action (including making and receiving declarations and consultations) or collect premiums on behalf of ABES Group AG or any insurer.
I (we) have never had any ongoing debt collection or loss certificates either privately or as a member of a bankrupt company.
There are no criminal convictions against my (our) person.

It must be possible to mark all points positively so that the application can be checked.

Desired recording date

Additions and remarks

I confirm that Privacy policy and the Cookie Policy and I declare that I have read and agree to this.
I reject the Privacy policy and the Cookie Policy from.

The use of this form serves to check the details for admission as a pure address broker of ABES Group AG©. It is also available without electronic registration and creation of a user account for an applicant. The submission serves the sole purpose of checking the application. The sender will not receive any further messages from ABES Group AG© for advertising purposes. ABES Group AG© checks the documents and contacts the applicant personally. If the application is rejected, all data will be deleted and the applicant will be informed. Rejections can be made verbally, in writing or electronically and do not have to be justified by ABES Group AG©.

I am not a robot:

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