Privacy Act Authorisation

Privacy Act and Information Authorisation (we do not sell or use your details for any third party marketing)

First and Last Name*
Date of Birth (DD-MM-YY)*
Male / Female*
- Male
- Female
Smoker*
- Yes
- No
Email Address*
Contact Number*
Mobile Number
City*
Occupation*
Terms and Conditions and Privacy Policy*
I/We have read, understood, and accept the privacy policy. I/We agree that Ease Insurance can provide services, information and advice to us relating to insurance. I/We authorise the collection and holding of our information, and disclosure of our details to any third parties that provide an operational service to Ease Insurance.
Read Privacy Policy here : https://easeinsurance.co.nz/privacy-policy/