REQUEST A QUOTE FORM


Letter of authorization




For the purpose of obtaining one or more insurance quotations and in order to enable fair underwriting of insurance risks, hereby authorize the Insurance Administrator to access my credit information held by one or more of the registered credit bureaux as well as to verify and share policy and insurance claims information with insurers and other institutions.



Personal Details










General Questions




RadDatePicker
Open the calendar popup.






























Buildings






Motor



GWM, Audi, etc.







Driver Details:





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RadDatePicker
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Other Details:


















SmallCraft:







House Contents







All Risk












Optional Cover


















Disclaimer

By accepting the disclaimer:
  • I warrant that the answers on this proposal are true and complete and I do not know of any material facts, even though specific questions about them have not been asked, that should be communicated to the insurer.
  • I agree that this proposal shall be the basis of the the contract between the Insurer and myself and that if this proposal is being filled in on my behalf, the person doing so is acting as my agent.
  • I will accept the standard Brolink Personal Policy wording and schedule.
  • I know that this insurance will not commence until this proposal has been accepted bu the insurer.
  • I agree that Brolink may utilize the records of one or more of the registered Credit Bureaux to: Perform a credit search when assessing my application for insurance; monitor my payment behavior; record the existence of my policy and transmit details of my claims and of how my premium payments are conducted

           

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