"
*
" indicates required fields
Who are you protecting?
*
Just me
Me and my partner
My family
My business
Do you reside in NZ?
*
Yes
No
Are you
*
Employed
Self-employed
Not currently working
Your Age
*
20-30
31-40
41-50
51-60
60+
Household Income
*
0 – 100k
101k – 150k
151k – 200k
201k +
Do you have current insurance (Life/Health/Income/Mortgage Cover)?
*
Yes
No
Do You
*
Rent
Own home with mortgage
Own home mortgage free
Is your business based in New Zealand
*
Yes
No
What type of Business is it?
*
Sole Trader
Limited Liability
Partnership
Are there multiple shareholders?
*
Yes
No
How many employees in the business?
*
1-5
6-19
20-50
50+
What are you looking for?
*
Shareholder Protection
Key Person Cover
Employee Benefits
Not Sure
Do you have existing business insurance plans?
*
Yes
No
Contact name
*
Position
*
Mobile number
*
Email Address
*
Preferred Contact time
*
Morning
Afternoon
Evening
Comments
Name
This field is for validation purposes and should be left unchanged.
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