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CLOSING INSURANCE ACCOUNT FORM
ACN: 110 581 809 Fireline Group Pty Ltd Trading as Switchbanks B/N 198 192 49

Switch Insurance/Close your Insurance

Dear Manager/clerk or organisation,

I request that my Home/Home Contents/ Motor Comprehensive/ Third Party/ Other

_____________________ (circle one) be closed.

If this form is not sufficient information to authorise the closure of my Insurance account please forward to me the appropriate forms to ensure proper closure

Thankyou for your assistance in this matter. TIME FORM FILLED OUT

PLEASE SELECT THE INSURANCE COMPANY YOU ARE SWITCHING/CLOSING

* First Name :
* Last Name:
* YOUR POLICY NUMBER HERE:	CANCEL
* ANY OTHER POLICY NUMBERS HERE
* SWITCHBANKS :	INFORMATION NEEDED FROM SWITCHBANKS NO MORE INFORMATION NEEDED
* E-mail Address:
* Phone number:
Fax number:
Work Number :
Mobile number:

SELECT THE POLICY INSURANCE YOU HAD?
Your Address:
City:
State:
Post Code:
Country:
* YOUR NEW ACCOUNT NUMBER HERE:
*CLOSING ACCOUNT YES/NO
* SWITCH/CLOSING:	PLEASE CLOSE MY ACCOUNT AND SEND CHEQUE PLEASE SEND MY LAST ACCOUNT BILL ASAP
* New Address:
* Additional Policies:
:
:
:

SELECT REASON WHY YOU ARE CLOSING YOUR INSURANCE OR SWITCHING

Comments/Questions:
Switchbanks thanks you for the opportunity to submit your closure form. “Insurance solutions have now taken a real turn,” Authorised Approval Signature:…………………………………….

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