Rate my experience

Online quotes enquiry form

Step 1: Policy details

Policy details

Policy number

What is your relationship to the customer

Adviser details

Adviser ID/Code

Your name

First name

Last name

Your contact details

Email address

Phone number

Mobile number

Customer details

First name

Last name

Date of Birth

(DD/MM/YYYY)

Customer address

Country

Address

Customer contact details

Email address

Phone number

Mobile number

Step 2: Enquiry details

Type of quote required

What is their occupation title?

What industry do they work in?

How long have they been working in their current role?

Do they hold any professional/trade qualifications?

Please give details including the type of qualification and the name of the institution where the qualification was obtained

In their main occupation, what percentage of time do they spend performing the following types of duties. Total duties = 100%

Sedentary/Administrative

Supervising manual work

Light manual

Heavy manual

Home duties (please include details of dependants including ages and any other relevant information)

Other (including hazardous duties e.g. handling dangerous substances, working at heights/underground/offshore or refinery)

Do they have any other occupation or jobs?

Please provide details including job title, duties, number of hours per week worked and annual income derived from their other occupation or jobs

For proposed upgrades to AA rating only - please advise their annual income for the past 2 financial years

Do they work in the mining industry?

Soft rock or hard rock?

Do they work underground?

Are they involved with the use of explosives?

Request type

Comments to support your enquiry

Please attach any supporting documents relevant to your request

Attach document

Unlimited number of files can be uploaded to this field.
15 MB limit.
Allowed types: pdf, jpg, png.
15 MB limit per form.

File size limit is 15 MB limit.
PDF, PNG, JPG are the only file types that can be submitted.

CAPTCHA

Important information

Resolution Life Australasia Limited ABN 84 079 300 379, NZ Company No. 281363, AFSL No. 233671 (Resolution Life). The content on this website is for information only. The information is of a general nature and does not constitute financial advice or other professional advice. Before taking any action, you should always seek financial advice or other professional advice relevant to your personal circumstances. While care has been taken to supply information on this website that is accurate, no entity or person gives any warranty of reliability or accuracy, or accepts any responsibility arising in any way including from any error or omission.

A disclosure statement is available from your Adviser, on request and free of charge.