PROFESSIONAL INTRODUCER

Please complete the following two stages in order to apply to become a professional introducer to Proactive Medical & Life Ltd.

Stage 1 - Complete the editable contract, save it and then attach it to the questionnaire below:

Stage 2 - Complete the questionnaire and attach the signed contract

Date the contact, complete your business name & address and sign the contract before attaching it to the questionnaire below.

020 8207 7394

Clarendon House Business Centre, 125 Shenley Rd, Borehamwood WD6 1AG, UK

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©2020 PROACTIVE MEDICAL & LIFE LTD REGISTRATION NUMBER: 06483379 IS AN APPOINTED REPRESENTATIVE OF HEALTHNET SERVICES LIMITED, WHO ARE AUTHORISED AND REGULATED BY THE FINANCIAL CONDUCT AUTHORITY. HEALTHNET SERVICES LIMITED ENTERED ON THE FCA REGISTER NO 312313