Letter of Appointment

Appointment
The party or parties named below (‘we’, ‘us’, ‘our’) appoint you as our insurance broker effective from the date we signed this appointment below.

Cancellation
We cancel our appointment of any previous insurance broker from that date and we authorise you to advise any previous insurance broker of this appointment.

Authority
We authorise you to act for us as our insurance broker which is available to us upon request and we can read them on our website.

Client Type

CommercialDomestic

Insured / Company Name

Please provide your registered company name if applicable

Multiple Insured / Company Name

Insured / Company name cannot contain “,*,:,,?,/,|, Please check your response

First Name

Last Name

Phone Number

Area or Mobile CodePhone Number

E-mail

example@example.com

Policy Number

Role

Commercial

Domestic

Date

Signature