Letter of Appointment

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.
Client Type*

CommercialDomestic
Insured / Company Name
Please provide your registered company name if applicable
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
Enter 'TBA' if unsure of policy number
Role
Commercial

Material DamageCommercial MotorContractors Plant & MachineryGeneral LiabilityManagement LiabilityProfessional IndemnityCyber LiabilityCarriers LiabilityMarine CargoOther
Domestic

HouseContentsPrivate VehicleMotorcycleBoatOther
Date

DayMonthYear
Date
Signature

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Signature File Upload

Cancelof
Should be Empty: