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Referring

A quick, simple and easy process to refer your clients to Allianz

Please complete:

Please read the below statement to your customer prior to completing the referral form.

Do you consent to Allianz contacting you by telephone or email about the insurance products you have selected to provide you with a quote and so that you can apply for cover?

If you consent, your information will be shared with Allianz Australia Insurance Limited. You can find more information about their Privacy Policy which can be found on the Allianz website.

By ticking this check box, you acknowledge that you have read the above statement to your customer and obtained their consent.

Referrer Details.
Name:*
Referrer Code:*
Mobile:*
Office number:
Email:*
Referrer Group:*
Client Details
First Name:*
Surname:*
Contact number:*
	Mobile Work
Preferred contact time:*
Email:
Product Details
Preferred product:*	Building Contents Landlord Motor
Loan type:*	New Loan Refinance Customer Initiated Other
Expected settlement date:
Enquiry:

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