For Intermediary Use Only

Refer GI Directly to Paymentshield

HL Partnership and Paymentshield have combined resources to offer you a referral service for your Home Insurance customers.

If you recognise that Home Insurance is important to protecting your client bank whilst generating an income then why not refer your clients to Paymentshield.

By filling out the below form, your referral will go to Paymentshield who will contact your client for a quotation.

Please note that this form is not an application form. You must discuss the policy features and benefits with your client to ensure that it meets their demands and needs before submitting an application on your behalf.

FCA Number

Adviser Name

Adviser Email

Adviser Telephone

Client 1: Title

Client 1:Full Name

Client 2: Title

Client 2: Full Name

Client 1: Email Address

Client 2: Email Address

Client 1: Telephone

Client 2: Telephone

Type of Cover Required

Policy Start Date

Disclaimer

I understand that on Submission of this form, Paymentshield will contact the customer to produce an insurance quotation. By submitting this form, you confirm that your client(s) have/has given permission for Paymentshield to contact them regarding a quote.

Contact Information

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HLPartnership is a trading name of HL Partnership Limited. Registered in England No.5011722. Registered Office: First Floor Office, 6 Merus Court, Meridian Business Park, Leicester LE19 1RJ. HLPartnership Limited is authorised and regulated by the Financial Conduct Authority. FS Register number 303397.