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Life Insurance Partners – Referral Form Page

This form is to allow Supervision to send your details to Life Insurance Partners as a referral for Life Insurance products.

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Life Insurance Partners- Referral Form

Start your Insurance Journey by completing the form below

Name(Required)

First Last

Phone Number - Best Number for Contact(Required)

Email(Required)

What Time are you available to be contacted by phone?(Required)

I am available any time during normal business hours

I would like to choose the time of your call

Time(Required)

Hours

:

Minutes

AM/PM

State - Time zone(Required)

WA - (WST)

SA & NT (ACST)

QLD (AEST)

NSW, Vic, TAS (AEST)

What time zone do you live in?

What type of insurance would you like to review?

Life

Total Permanent Disability

Trauma

Income Protection

I'm not sure about my requirements

Please select one or more of the different types of insurance. If you are unsure of what insurance to choose, that's OK.

Acknowledgements and Consents

Supervision has not provided any financial advice.

I understand Supervision will receive a referral fee if insurance is completed with Life Insurance Partners.

I have read Supervision's Financial Services Guide (FSG) which describes the referral fees in detail.

I give consent for Supervision to share my personal details with Life Insurance Partners.

I understand the information I have provided in this application is for the purpose of receiving insurance.

To proceed, please accept the conditions above.

Contact us

Supervision SMSF Solutions (ACN 134 666 596) AFSL 435751

Office: 1300 693 863

[email protected]

Level 1, 76 Mill Point Road
South Perth, WA, 6151

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Disclaimer

All information provided on this website does not consider any of your investment objectives, financial situation or particular needs and should not be in any way considered as financial advice. SUPERVISION does not provide financial product advice or recommend any financial products or whether you should establish an SMSF. This applies equally to those financial products which are established for any entity or when you become a client of SUPERVISION. We also recommend that you seek professional advice from a financial adviser before making any decision to establish an SMSF or purchase any financial product referred to on this website. Please refer to Important Documents. While the sources for the material are considered reliable, responsibility is not accepted for any inaccuracies, errors or omission. Supervision SMSF Solutions (ACN 134 666 596) AFSL 435751. Contact us 08 9367 9655 or [email protected]

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