Partner Programme

Intermediary Application

Complete the form below to apply. Applications are reviewed within 3–5 business days. Once approved, you will receive portal access to start quoting and enrolling clients.

1Business Information

Business / Company Name *

Business Type *

Country *

City *

Website

Business Registration Number

2Primary Contact

First Name *

Last Name *

Job Title

Email Address *

Phone Number *

3Your Client Base

Who do you primarily sell to? *

Estimated Annual Policies *

Existing International Health Clients

4Declarations

I agree to the Globalwide Health Intermediary Terms & Conditions.

I confirm that my business operates in compliance with applicable laws and regulations in my jurisdiction, including any insurance distribution requirements.

Your application will be reviewed within 3–5 business days. We will contact you at the email address provided.