Preliminary Insurance Information (INA)

Preliminary Information

Tell us a little more about yourself
Let's get you insured

This is the first step to getting an insurance protection package that is tailored to your needs. Before we begin, here's a quick overview of what to expect.

In this form we will ask you some basic questions regarding your situation. The answers to these questions will direct the conversation in our 30 Minute Consultation.

Booking your 30 Minute Consultation

Post completion of this form, you will be invited to book a time for your 30 Minute Consultation via our automatic calendar booking system.

The consultation is done via either Zoom or phone. If you have access to a computer with a camera and a microphone, Zoom is the best option so we can have a virtual face-to-face and share information on the screen.

What happens after the Initial Consultation?

If, during the consultation, you decide that you would like to proceed with an insurance application, we will then prepare and present a Statement of Advice with all of the relevant detail.

The cost to prepare and present this advice is a flat $330 inclusive of GST. This also covers the cost of implementation, should you decide to go ahead.

Ready to get started? Let's go!

The basics
Name*

First NameLast Name
DOB*

DayMonthYear
Email*
Phone number

Area CodePhone Number
State*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

A few medical / lifestyle questions
Gender*

FemaleMaleTransgenderNon-binary / non-conforming
Have you smoked cigarettes in the last 12 months?*

NoYes
What is your height?
What is your weight?
Are you self-employed?*

NoYes
How many hours do you work on an average week?
What is your occupation? If you have multiple occupations, please list them all with an estimate of time spent at each.
If you have changed your occupation in the last 12 months, please let us know your previous occupation.
Do you have any professional or trade qualifications?
Do you have any current or previous medical issues which you believe may impact your ability to get cover?

Congratulations your form is complete!
By clicking submit below you will be redirected to our booking system to lock in your 30 Minute Consultation via either video meeting (a Zoom invite link will be included in your calendar invite) or phone call.

If you can't find a time slot that is appropriate for you, we are very accomodating and invite you to contact us directly to arrange an out of hours appointment.
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