Transaction Confirmation Informed Consent This field is hidden when viewing the formWork Request IDInsurer Commission - Policy DetailsThere are some changes in legislation, and we need your consent to receive commission on your policy before we place cover. OFFICE USE ONLY - DO NOT EDIT THESE FIELDSInsurerType of InsurancePayment FrequencyAnnualMonthlyRange of Commission1% to 20%20% to 40%Please Note1) All our services are outlined in our terms of engagement, which will be sent to you. 2) Your consent will apply to future renewals of these policies and is binding. 3) We will contact you or seek a variation of the consent if any of the above items change.Informed Consent - CLIENT TO SIGNName(Required) First Last I, the above named, consent for my Broker to earn commission for their services:Yes - via websiteSignatureDate MM slash DD slash YYYY GET A QUOTE Discover the Elliott Insurance difference request a quote
