Authority to provide information

This form is for you to grant TGN Advisers the authority to talk to your current insurer about your cover BUT DOES NOT allow us to change anything, the authority only lasts for a short time.

Please also indicate which insurances you would like us to review for you.

Instructions - please fill in this form and sign on the screen using a touch screen device such as a smartphone or tablet. If you do not have access to one then please scroll to the bottom, download, fill in and scan the pdf back to george@tgn.co.nz
Authority to provide information

TGN Advisers
TGN Advisers have been instructed to assist me/us with financial advice.

Please record this and provide any requested information, including medical information, as soon as possible. This authority releases you from associated claims under the Privacy Act 2020. Please treat a fax, scan, email or photocopy of this authority as if it was an original and it is not necessary to contact me/us in regards to this.

I / we confirm that the above has been read and understood.
Signature Person 1

Clear
Name Person 1

First NameLast Name
Date of birth person 1

DayMonthYear
Signature Person 2

Clear
Name Person 2

First NameLast Name
Date of Birth Person 2

DayMonthYear
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Todays date

DayMonthYear
Types of Insurance to review - there is no charge (please tick)

LifeTraumaTPDIncome ProtectionMortgage ProtectionMedicalHouseContentsVehicleOther
Life Insurance Companies

AIAAMP, AXAANZASBAsteronBNZCignaFidelityKiwibank, Kiwi InsureOnepathPartners LifePolice AssociationSovereignWestpacOther
Medical

AccuroMASnibSouthern CrossSovereignUnimed
Home, Contents and Car

AAAMIStateTowerVeroNZIOther
Vehicle Number Plates
If you haven't already made a time for your complimentary no obligation insurance review please make an appointment by clicking here

TGN Advisers is a subsidiary of TGN Investments Limited (Reg No.FSP716191) which holds a licence issued by the Financial Markets Authority to operate as Financial Advice Provider (FAP). TGN Advisers provides advice to our clients about life insurance, health insurance and fire and general insurance. Your financial adviser for these products will be George Bayley (Reg No.FSP405807).
If you would prefer to download, print, fill in, sign and scan / photograph the physical form back to us please download the form below and email back to admin@tgn.co.nz-
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