Insurance Fact Find

Who is this for?
Partner 1
Name*
First Middle Last
Gender*
- Male
- Female
Email
Date of birth*
Date Format: DD slash MM slash YYYY
Smoker*
- Yes
- No
Residency Status*
- Work Visa < 2 years
- Work Visa > 2 years
- Residency / Citizenship
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
Residency Status*
- Work Visa < 2 years
- Work Visa > 2 years
- Residency / Citizenship
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?

Location:

Unit 2, 1 Airborne Road, Rosedale,

Auckland,

0632

Phone:

0800275637

Partner 1