At AFP Coburg we broke the market to ensure you get the best policy at the best premium. Given our size we are able to negotiate with insurers on your behalf to ensure they are doing the best deal for you!

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Personal Details

Salutation

Smoker?**

First Name*

Surname

Date of Birth

Gender

Email Address*

Phone

Street Address

Suburb

State

Postcode

Occupation

Or describe Occupation

 

** select smoker if you have smoked in the last 12 months

 
 

Current Cover Details

Please complete the following in regard to your current insurance and we can then provide a comparison for

you to consider.

Life / TPD / Trauma Cover   

Current Life Company

Policy Name (if you know)

Amount of Life cover

$

  

Amount of TPD cover

$

  

Amount of Trauma cover

$

  

Premium

$

  

How Often

 

Income Cover

Current Company

Policy Name (if you know)

Monthly benefit under current policy

$

  

Waiting Period

Benefit Period

Premium

$

  

How Often

 

Referred By

(only complete if you have been referred by an existing client)

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