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

2Licensed Brokers & Intermediaries Only

Globily works exclusively with appropriately licensed or authorized insurance brokers and intermediaries. Applicants must hold a valid license or regulatory authorization permitting them to distribute the applicable product in their country of domicile and/or the jurisdiction where they conduct business. License verification is required before appointment and access to our intermediary program.

Country of Domicile *

Country / Countries of Operation *

Regulatory Authority *

License / Registration Number *

License Expiration Date *

Upload License / Authorization *

3Primary Contact

First Name *

Last Name *

Job Title

Email Address *

Phone Number *

4Your Client Base

Who do you primarily sell to? *

Estimated Annual Policies *

Existing International Health Clients

5Declarations

I agree to the Globily Intermediary Terms & Conditions.

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

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