Broker Appointments

Please fill out the below form if you're interested in joining our network of brokers.

Broker Information

Full Name

Position

Email

Phone

Company name

Corporate Address

Book of Business Overview:

Primary homestate of business:

Other states operating in:

Total Volume (Premium) (Est.)

Total E&S Commercial Real Estate Premium (est.):

Of that, what % is Residential

Of that, what % is Commercial

Monthly # of E&S Commercial Real Estate Binds (ave):

Current E&S Markets

Opportunity Outlook:

Please describe why you are seeking an appointment with CIBA

Expected # of submissions sent to CIBA monthly:

Expected # of Binds with CIBA Quarterly:

CIBA has a target bind goal for each broker appointed. The goal is monitored and recorded on a 6 month basis. What do you feel is a reasonable goal? (xx # binds, or xx premium, etc.)

Pipeline:

Please provide details for up to 4 accounts that would be potential opportunities with CIBA in the coming months:

Account 1:

Effective Month

Occupancy

State

Year Built

# Buildings

Reason for Opportunity (new, renewal, cancel, etc)

Account 2:

Effective Month

Occupancy

State

Year Built

# Buildings

Reason for Opportunity (new, renewal, cancel, etc)

Account 3:

Effective Month

Occupancy

State

Year Built

# Buildings

Reason for Opportunity (new, renewal, cancel, etc)

Account 4:

Effective Month

Occupancy

State

Year Built

# Buildings

Reason for Opportunity (new, renewal, cancel, etc)

Broker Appointments

Broker Information

Book of Business Overview:

Opportunity Outlook:

Pipeline:

Find an Authorized CIBA Broker

Learn about the
CIBA Difference

Broker Appointments

Broker Information

Book of Business Overview:

Opportunity Outlook:

Pipeline:

Find an Authorized CIBA Broker

Learn about the CIBA Difference

Learn about the
CIBA Difference