Personal details

First name *

Last name *

Email address *

Phone number *

Business details (if applicable)

Company / trading name

NZBN

13-digit business number — optional

Your role in the business

Existing policy / client reference

Found on your invoice — starts with C3 or PEN

Why do we need this? To act on your behalf we need to be able to contact your current insurer or broker, request your policy details, and arrange a smooth transfer of your cover to Turbo Insurance.

Current insurer or broker

Insurer or broker name *

Policy renewal date

Approximate is fine — found on your policy schedule

Policy number(s)

Any notes about your current cover

Insurance types covered by this authority

Select all that apply — tick everything if you'd like Turbo to review your full insurance programme.

Permitted actions

What can Turbo Insurance do on your behalf?

Duration of authority

Start date

End date

Leave blank = ongoing until revoked in writing

Authority received — thank you

Your Letter of Authority has been submitted successfully. A confirmation has been sent to your email. The Turbo Insurance team will be in touch within one business day to confirm next steps.

Reference:

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Authority statement

I/We, [your name], hereby authorise Turbo Insurance and Risk Limited (FSP1009977), as a licensed financial advice provider and member broker of Insurance Advisernet New Zealand, to act as our insurance broker and adviser for the insurance types and purposes selected in this form.

This authority permits Turbo Insurance to contact our current or previous insurers and brokers to request policy information, claims histories, and any other records necessary to provide us with insurance advice and brokerage services.

I/We understand that Turbo Insurance acts on our behalf — not on behalf of any insurer — and that their duty of care is owed to us as the client. This authority may be revoked at any time by written notice to Turbo Insurance and Risk Limited.

Declarations

I confirm the information in this form is accurate and complete to the best of my knowledge. I have read and understood the scope of authority granted by this document and agree to its terms. I understand I may revoke this authority at any time by providing written notice to Turbo Insurance. I consent to Turbo Insurance collecting and storing my personal information in accordance with the Privacy Act 2020 and Turbo Insurance's Privacy Policy.

Electronic signature

Full legal name *

Typing your name is a valid electronic signature under the Contract and Commercial Law Act 2017 (NZ).

Date signed

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