Refer a Client

This page provides our network of referral partners with an easy and efficient way to send their new client referrals to our team of qualified and experienced insurance brokers.

If you are not a current referral partner and would like to become one, please contact our office on 1800 273 256.


  • Who are you referring to us?

    This section of the form captures information about the client you are referring to Steadfast Brecknock and will allow us to make contact with them.
  • Enter the first name and surname of the person we should contact
  • Enter the client's business or company name (if applicable)
  • Enter the contact person's email address
  • Enter the contact person's phone number (including area code)
  • Enter the client's website (if applicable)
  • Enter the client's physical address (if known)
  • Insurance Needs

    This section of the form captures information about the type of insurance the client has client expressed an interest in. If the client is unsure, please select "unsure".
  • What type of insurance has the client expressed an interest in?
  • Additional Information

    This section of the form allows you to provide us with any additional information.
  • Enter any additional information you wish to bring to our attention.
  • Referral Partner Details

    This section of the form is used to identify you - our referral partner. We will contact you if we require further information. We will apply your unique referral partner code against the referral provided. If you do not know your unique referral partner code, please contact our office.
  • Enter your unique referral partner code
  • Enter your business or company name
  • Enter the first name and surname of the authorised person acting on behalf of the referral partner
  • Enter the email address of the authorised person completing this form
  • Enter the referral partner's phone number (including area code)
  • By ticking the box below, you declare that you have spoken to the client you are referring to Steadfast Brecknock Insurance Brokers and the client has agreed for one of our qualified and experienced insurance brokers to contact them about their insurance needs. You also agree that the information you have provided us with on this form is complete and accurate to the best of your knowledge. You also acknowledge that referral partner rewards will only be considered if you have a current referral partner agreement with Steadfast Brecknock which governs the referral agreement terms and conditions.