By filling out the below form, you’ll give Coromandel Insurance Services permission for us to be your authorised Adviser. We can collate all your insurance details and take care of all your insurance needs for you.

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    Are any of your existing insurance policies joint partner policies OR would your partner also like Coromandel Insurance Services to act as their Adviser? Please check YES or NO.

    Your Existing Insurance

    Please provide details of your existing insurance below. Coromandel Insurance Services will then contact each insurance company for you to retrieve all your premium details (including any relevant policy documents).

    Authority to investigate as Insurance Adviser

    I/we give authority to Coromandel Insurance Services and its authorised representatives to investigate the above insurances. I authorise pursuant to the provisions of the Privacy act 1993, Coromandel Insurance Services to contact my/our insurers to obtain, check, disclose or exchange information for the purposes of acting as our Agent, Adviser and/or Broker.

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