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

SWITCH OR CLOSE INSURANCE RACQ AUSTRALIA AUSTRALIAN PENSIONERS COMMINSURE AAMI WESTPAC INSURANCE REAL INSURANCE NRMA PRUDENTIAL INSURANCE QBE INSURANCE ALLIANZ ING INSURANCE AUSTRALIAN UNITY PLEASE SELECT THE INSURANCE COMPANY YOU ARE SWITCHING/CLOSING

* First Name Mrs. Mr. Ms. :
* 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:
SWITCH INSURANCE/CLOSE HOME INSURANCE MOTOR COMPREHENSIVE INSURANCE THIRD PARTY HOME CONTENTS INSURANCE OTHER   SELECT THE POLICY INSURANCE YOU HAD?
Your Address:
City:
State:
Post Code:
Country:	United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Belarus Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Colombia Comoros Congo, Dem. Rep. of the Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guinea Guinea-Bissau Guyana Haiti Heard & McDonald Is. Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Is. Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda St. Helena Saint Kitts and Nevis Saint Lucia St. Vincent & Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Svalbard & Jan Mayen Is. Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis & Futuna Is. Western Sahara Yemen, Republic of Yugoslavia Zaire Zambia Zimbabwe Not Listed
* 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:
:
:
:
SWITCH INSURANCE/CLOSE HAVE OTHER INSURANCE YOU ARE TOO EXPENSIVE RECIEVED A LOWER QUOTE TRYING A NEW INSURANCE COMPANY PLACNG ALL INSURANCES INTO ONE   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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