test loa

Letter of Authority to Review and Quote

To Whom It May concern,

We/I authorize out current insurer(s) to provide All Star Brokers Pty Ltd (as an Authorised Representative of Community Broker Network Pty Ltd, AFSL No. 233750) with all information excepting coverage details and premiums paid which they might request regarding our insurances and claims history over the last

or from

in respect of the following classes of insurance.
 

 
 
This authorisation in no way constitutes the appointment of

  
This authorisation is valid for the period from:

 
Kind Regards,
(Please sign below before submitting)*