Update My Details

 

This page provides clients of Steadfast Brecknock Insurance Brokers with an easy and efficient way to request updates and changes to the contact details we hold on file for them.

Any information or requests relating to a change to an insurance policy will not be accepted or acted upon using this form. To request a change to your insurance policy, please contact your Account Manager or contact our office on 1800 273 256.


Update My Details Request Form

  • Enter your unique client code (refer to your invoice)
  • Requesting changes to your contact details

    To request a change to the contact details we hold on file for you, only complete the details you want updated.
  • Enter your business name (if applicable)
  • Enter your postal address
  • Enter your website address
  • Enter your main email address
  • Enter your main phone number (including area code)
  • Enter your main fax number (including area code)
  • Specifying a Primary Contact Person

    You can nominate up to two contact persons on this form for your insurance policies. You can specify a primary contact person and a secondary contact person. This section of the form allows you to specify your primary contact person.
  • Enter the primary contact person's first name, surname and job title
  • Enter the primary contact person's date of birth
  • Enter the primary contact person's email address
  • Enter the primary contact person's phone number (including area code)
  • Enter the primary contact person's fax number (including area code)
  • Enter the primary contact person's mobile phone number
  • Specifying a Secondary Contact Person

    You can nominate up to two contact persons on this form for your insurance policies. You can specify a primary contact person and a secondary contact person. This section of the form allows you to specify your secondary contact person. If you wish to nominate additional contacts, please contact our office.
  • Enter a secondary contact person's first name, surname and job title
  • Enter the secondary contact person's date of birth
  • Enter the secondary contact person's email address
  • Enter the secondary contact person's phone number (including area code)
  • Enter the secondary contact person's fax number (including area code)
  • Enter the secondary contact person's mobile phone number
  • Additional Information

    This section of the form allows you to provide us with any additional information regarding changes to your contact details.
  • Enter any additional information regarding changes to your contact information. Changes required to an insurance policy will not be acted upon using this form - you are required to contact your Account Manager or contact our office.
  • Who has completed this form?

    This section of the form captures information about the person completing this form. You must be an authorised person in order for changes to be considered and/or made.
  • Enter the first name, surname and position title of the authorised person who is requesting the changes specified above
  • Enter the email address of the authorised person requesting the above changes
  • Enter the phone number (including area code) of the authorised person completing this form
  • By ticking the box below, you declare that you are authorised to request the contact information changes specified above which relate to the specified client code only. You also agree and acknowledge that any changes requested above will not be made to any insurance policy. If you require changes to be made to an insurance policy (including risk addresses) you must contact your Account Executive or contact our office. All changes requested on this form are for client contact details only.