Letter of Authority — Benchmark Insurance Brokers

Your Details

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Full Legal Name *

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Your Position / Title *

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Company / Business Name *

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ABN (optional)

Business Address *

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Insurance Details

Current Policies & Insurers

List each policy on a new line with insurer and policy number where known.

Effective Date *

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Signature

Your Signature *

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I confirm I have read this Letter of Authority, understand its purpose, and have the authority to sign on behalf of the above entity. *

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Authority Received

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Reference:

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Benchmark Insurance BrokersAuthority to Review & Quote

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Your name

To whom it may concern,

Authority to Review and Quote

Effective date, I authorise the current and former insurers of your company to provide Benchmark Insurance Brokers with all information (other than premium information) which they request regarding the following insurances and claims history over the past 5 years for your company:

Policy details will appear here

This authority is provided to enable Benchmark Insurance Brokers to review and quote on our insurance arrangements. This does not necessarily appoint them as our insurance broker.

Whilst this letter of authority is not on any letterhead, I attest to its authenticity and intent in my capacity as your position of the company.

In the event that the Broker receives any personal information from the Insurer, they are required to handle it in accordance with their Privacy Policy.

Yours faithfully,

Signature

Awaiting signature

Signatory

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Benchmark Insurance Brokers is an Authorised Representative of McLardy McShane Partners Pty Ltd | AFSL 232987 | ABN 14 064 465 309
AR No. [to be inserted] · Financial Services Guide · Privacy Policy

Authority to Review& Quote

Your Details

Authority to Review
& Quote