Complete the form below to be sent a quote through to your email.
Do you currently have any Insurance or KiwiSaver through Wealthpoint?* —Please choose an option—No, I'm new to WealthpointInsurance - Life, Income, or HealthInsurance - Domestic, Commercial, or FarmKiwisaver
Who is your current insurer?
What cover do you currently have?
How did you hear about us?
Reason for quote Quality of coverQuality of serviceQuality of claimsProactive adviceDissatisfaction with current providerPrice
Policy number
Who is your Adviser? —Please choose an option—Bevan SterlingKim SterlingStuart SterlingOther/Unsure
Premium frequency* —Please choose an option—YearlySix-MonthlyQuarterlyMonthlyFortnightly
Type of cover you require* HomeContentsVehicleBoatTrailer, Caravan, or Horsefloat
Note - For home insurance, please first fill out this form and then separately fill out our Home insurance form to receive your quote.
Note - For contents insurance, please first fill out this form and then separately fill out our Contents insurance form to receive your quote.
Note - For vehicle insurance, please first fill out this form and then separately fill out our Vehicle insurance form to receive your quote.
Note - For boat insurance, please first fill out this form and then separately fill out our Boat insurance form to receive your quote.
Note - For trailer, caravan, or horsefloat insurance, please first fill out this form and then separately fill out our Trailer, Caravan, or Horsefloat insurance form to receive your quote.
What date would you need cover to start?
Full name*
Postal address
Date of birth*
Email address*
Best contact number*
Have you or your family members or any other person or entity to be covered by the insurance made more than two claims or losses in the last two years? YesNo
Have you or your family members or any other person or entity to be covered by the insurance been bankrupt in the last 10 years? YesNo
Ever suffered from flooding or landslip at any address relating to this policy? YesNo
Have you had any insurance declined, cancelled, avoided, renewal refused, terms imposed or claim denied? YesNo
Have you engaged in any criminal activity or had any criminal convictions, acquittals or diversions, or have any criminal prosecutions pending? YesNo
Is there any further information likely to affect this insurance? YesNo
Additional notes or queries that may affect your insurance?
