About
Meet the Team
Newsletter Signup
Our Services
Personal Insurance
Business Insurance
Business Advisory
Home Loans
ACC
KiwiSaver
New Immigrants Network
Find out more
Blog
Contact Us
Insurance Fact Find
Who is this for?
Individual
Couple
Partner 1
Name
*
First
Middle
Last
Gender
*
Male
Female
Email
Date of birth
*
Date Format: DD slash MM slash YYYY
Smoker
*
Yes
No
Occupation
*
Annual Income
*
Mortgage Payments or Rent per month
*
Outstanding Mortgage
Estimate Value of Property
Outstanding Balance on Car Loans
Outstanding Balance on any other debts
For example personal loans, credit cards etc
Do you have any children?
*
Yes
No
Children's names, gender and ages
*
i.e. Eddie, boy, 5
Partner 2
Name
*
First
Middle
Last
Gender
*
Male
Female
Date of birth
*
Date Format: DD slash MM slash YYYY
Smoker
*
Yes
No
Occupation
*
Annual Income
*
Mortgage Payments or Rent per month
Outstanding Mortgage
Estimate Value of Property
Outstanding Balance on Car Loans
Outstanding Balance on any other debts
For example personal loans, credit cards etc
Finally
Do you have any current insurance policies?
*
Yes
No
Please detail your current policies below
*
Please include Insurance Company/Bank, Cover Type, Sum Insured eg: AA Insurance, Life Insurance, $500,000
Policies Info
Drop files here or
If you have copies of any policy documents, please upload them here.
Any other information you would like to share?
