This form is intended to ensure your Daberistic's Short-term Insurance Broker covers all the necessary areas of your personal insurance, when onboarding you as a client as well as when annually renewing your insurance policy.
This form should be completed by your Broker together with you, telephonically. Once completed and submitted, a copy of this record is automatically emailed to you for your review and safekeeping. If you find the record to be factually incorrect, please email firstname.lastname@example.org with your changes.
A copy of this record is automatically kept in our system for legal compliance purpose.