Workplace Quote Request

Number of Staff:
Contact Person:
Mobile Phone:
Work Phone:
Do you currently have a workplace scheme?: Yes No
What products would you like quotes for?

Workplace Life Insurance
Workplace Income Protection
Workplace Trauma Cover
Health Insurance
Workplace Living Assurance
How did you hear about us?
Yes, please subscribe me to your company newsletter.
Additional Details:
Please advise any information you are aware of which may influence our decision as to whether we prepare a quote or not, or the terms of our quote.

T.09 529 5017 - PO Box 9047, Newmarket, Auckland, New Zealand