LIMOSS | DDM Elective Registration

Section 1

Details of the person who entered this data

Please enter the details of the person completing this form on behalf of the organisation

Your name *

Your email *

Your position *

Section 2

Details of the organisation registering for DDM

Please provide details of the organisation you are registering for LIMOSS SSO and DDM

Full legal name of the organisation *

Organisation Type: Select all that apply

Managing Agent

Broker

Coverholder

TPA

Other

Is the New Company part of the Lloyds Market?

Yes

No

Address of the New Company to be registered

Address line 1 *

Address Line 2

Postcode*

For Coverholders, please list all Coverholder PINs associated with this organisation. List one PIN per line. Enter manually or copy and paste from Excel.

For Broker please specify the Number & Pseudonym associated with this organisation. Please list ONE per line. Enter manually or copy and paste from Excel

For Insurer please specify the Syndicate Number associated with this organisation. Please list ONE per line. Enter manually or copy and paste from Excel

The following pins appear to be invalid:

Section 3

Does your organisation already have access to LIMOSS Single Sign On (SSO)? *

Yes

No

Unsure

LIMOSS SSO Authorised Contact

Please nominate a LIMOSS SSO ‘Authorised Contact’ for your organisation. This person will work with us to on-board your company and named users into LIMOSS Single Sign-On (SSO). They will be the first person on-boarded and can then provide us with details of other users who require a LIMOSS SSO account. All requests to add or remove users of LIMOSS SSO must be approved by an Authorised Contact. Additional Authorised Contacts can be nominated later in the on-boarding process.

LIMOSS SSO Authorised Contact name

LIMOSS SSO Authorised Contact email

LIMOSS SSO Authorised Contact job title

LIMOSS SSO Authorised Contact phone number

Select this box if you would like to add another Authorised Contact now.

LIMOSS SSO Authorised Contact first name *

LIMOSS SSO Authorised Contact last name *

LIMOSS SSO Authorised Contact email address *

Select this box if you would like to add another Authorised Contact now.

LIMOSS SSO Authorised Contact first name *

LIMOSS SSO Authorised Contact last name *

LIMOSS SSO Authorised Contact email address *

Select this box if you would like to add another Authorised Contact now.

LIMOSS SSO Authorised Contact first name *

LIMOSS SSO Authorised Contact last name *

LIMOSS SSO Authorised Contact email address *

Section 4

Company Admin for DDM *

Please nominate a ‘Company Admin for DDM’ for your organisation. The Company Admin user for DDM must be a LIMOSS SSO User. This person will be the first person on-boarded onto DDM and will be responsible for adding and deactivating users within the application.

Please select this box if your organisation prefers not to have the DDM user default to a LIMOSS SSO Authorised Contact

Company Admin for DDM contact name

Company Admin for DDM contact email

Section 5

Authorised signatory for legal agreements

Please nominate an ‘Authorised Signatory’ for your organisation. There are a number of legal agreements that must be signed and returned to the LIMOSS Service Desk before your organisation can complete DDM on-boarding. We will liaise with this person to ensure all necessary legal documents are received, signed and returned.

Authorised Signatory name *

Authorised Signatory email *

By submitting this data, you are consenting that the data is used solely for the purposes of on-boarding your company and users onto DDM. Should you wish to withdraw your consent for us to use this data, please email confirming that your consent is withdrawn to servicedesk@limoss.london

DDM Elective Registration

DDM Elective Registration

Section 1

Details of the person who entered this data

Section 2

Details of the organisation registering for DDM

Section 3

LIMOSS SSO Authorised Contact

Section 4

Company Admin for DDM *

Section 5

Authorised signatory for legal agreements

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