WealthCover Full Insurance Enquiry

First Name *

Last Name *

Email *

Mobile *

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State or Territory *

Date of birth *

Sex listed for insurance quotation purposes *

Male

Female

Prefer to discuss

Smoker Status *

Yes

Prefer to discuss

Ownership Structure

Super

Personal Name

SMSF

Would you like to link your covers?

What is your occupation? For Income Protection & TPD quoting.

Would you like us to explain the main cover types during your call?

Occupation and duties

Emplyment Type

Do you perform manual work?

Yes

Some duties LESS than 20%

Some duties MORE than 20%

Approximate annual income before tax

I consent to WealthCover collecting and using health and lifestyle information for the purpose of responding to my insurance enquiry. I understand I need to provide this consent before continuing to the health and lifestyle questions. *

Yes

You need to provide this consent before continuing to the health and lifestyle questions.

Let us know the easiest way to contact you.

Best contact method

Best time to call:

Preferred appointment type:

Ready to submit your insurance enquiry?

By submitting this form, I consent to WealthCover contacting me about my insurance enquiry. I understand that WealthCover provides general advice only through this enquiry process. The information provided does not take into account my personal objectives, financial situation or needs. I should consider the relevant Product Disclosure Statement and Target Market Determination before making any decision. I confirm the information I have provided is true and complete to the best of my knowledge.

This enquiry form does not review existing insurance cover or provide a recommendation to cancel, replace, increase or reduce any existing cover.

I consent to WealthCover contacting me about my insurance enquiry. *

Yes

I understand this enquiry process provides general advice only and does not take into account my personal objectives, financial situation or needs. *

Yes

I understand I should consider the relevant Product Disclosure Statement before making any decision. *

Yes

I understand I should consider the relevant Target Market Determination before making any decision. *

Yes

I have read and accept the Privacy Policy. *

Yes

View our Privacy Policy here

Please review the WealthCover Financial Services Guide before submitting this enquiry. *

Yes

Download the WealthCover Financial Services Guide

I consent to WealthCover collecting and using health and lifestyle information for the purpose of responding to my insurance enquiry. *

Yes

WealthCover Full Insurance Enquiry

You need to provide this consent before continuing to the health and lifestyle questions.

These questions help us understand what information an insurer may require before providing terms.

Let us know the easiest way to contact you.

Ready to submit your insurance enquiry?