Cancellation Form

Complete this cancellation form for all insurance cancellations unless you have, or also have:

Professional Indemnity Insurance.

Asbestos Removal Insurance.

Directors and Officers Liability Insurance.

Management Liability Insurance.

Employment Practices Liability Insurance or,

Fidelity Insurance policy.

If you have one of these policies above click here

First Name*
Last Name*
Business Name*
Email Address*
Phone Number*
Policy number (If known)
Account details for refunds (Do not put in details if you pay monthly)
BSB
Account-Number
Have you had any claims or known unreported losses?*
Requested Date to be cancelled from*
Reason for cancellation and (if applicable) any claims or known unreported losses*
We offer finance broking as one of our services. Do you require pricing on any loans or finance?*
What type of finance do you require?*
Are you the sole person authorised to cancel this policy? Please note in some circumstances such as partnerships for example you may need permission from all parties involved.*
- I am the sole person authorised to cancel this policy
Please note that when a policy is cancelled midterm we retain any income we earn as brokers. If you are on monthly payments, you are still liable for the interest portion on the monthly payment contract. This may leave you with a shortfall that will need to be paid back to the funder. We do not know how much this amount is until we have finshed the cancellation process.*
- I understand and agree

Account details for refunds (Do not put in details if you pay monthly)