Apply for Membership

If you would like to become a member of the IBA, Ireland’s leading representative body for Insurance Brokers, please complete this short application form and one of our New Member Team will be in touch.

Application Form

Your contact details

Your Name Your Email

Your Telephone Number

Your firm's details

Firm's Full Name Trading Name Date Established (YYYY-MM-DD) Main Telephone Number Main Email Address

Business Street Address 1 Business Street Address 2 Town / City County

Central Bank authorisation details:

Central Bank Authorisation Number

Authorised Under: (Please check all that apply)

Investment Intermediaries Act 1995 MIFID Regulated Insurance Mediation Regulations (IMR 2005) Consumer Credit Act 1995 as a Mortgage Intermediary Consumer Credit Act 1995 as a Credit Intermediary

Product/Services provided:

Please tick which products and services you provide:

General Insurance Products

Motor Home Health Insurance Legal Expenses Commercial (Business) Travel Other

Financial Insurance Products

Pensions Life Assurance Mortgages Investments Other

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