Enquiry Form

Full Name:  *   Address:   Suburb:   State:   Postcode:   Contact Phone:   Mobile Phone:   Email:  *          Select Type of Cover       Type of Cover     (Please tick applicable box)           House Only Boat Business/Office/Retail Contents Only Caravan Farm/Crop/Livestock House and Contents Commercial Motor Public Liability Car Accident/Illness Travel     Other (Please specify)         Further Comments:   * Required details where applicable   Privacy Policy We know that you are concerned about your privacy. If you provide us with information about yourself or your business, such as name, postal/e-mail address or other data, this information may be added to our internal data records. All information received from you (either by mail/fax or in any electronic format), however, is used internally, by Allsure Insurance Agencies Int Pty Ltd staff members only. No details will be supplied to a third party, unless required by law/statutory obligation or with your express prior approval. Allsure Insurance Agencies Int Pty Ltd will not sell your personal information to any outside interests.