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DA application form - brokers and managing agents

You must also have a Lloyds.com account.

Managing agent or Lloyd's broker details

Firm's name

Address

City

Postcode

Devolved Administrator details

Title

Forename

Surname

Phone number

Email address

I wish to be a DA for:

Atlas
BAR

Are you replacing an existing DA?

If yes, who

Have they handed in their RSA SecurId token?

If you have moved firms were you previously a DA?

If yes, with which firm?

Details of person completing the form if different from above

Name

Date

Company Director name

I certify that I am authorised on behalf of the Firm named above to (i) execute this application, and (ii) appoint the Devolved Administrator. I further certify and confirm that the firm will be bound by the Atlas and Binding Authority Registration web-sites’ terms and conditions of use available on www.lloyds.com/atlas and www.lloyds.com/bar respectively, as may be amended from time to time.

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Access Atlas

Need help?

For help using Atlas speak to your Lloyd’s broker or managing agent. If they are unavailable please contact the Delegated Authorities Team:

Atlas helpdesk: +44 (0)20 7327 6276
Fax: +44 (0)20 7327 6688
Email: coverholders@lloyds.com

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