Ebix eBusiness Portal Application Form Ebix eBusiness Portal Application Form

The following application should be completed if:

Access to Sunrise is required, and your company is not using a Sunrise-compliant broking system

Company Name

Trading as

ABN

ACN

Company Phone

Company Website

Company Email

Address Line 1

Address Line 2

City/Suburb

State

Postcode

Country

Company Postal Address

Same as Company Street Address? Different Address

Address Line 1

Address Line 2

City/Suburb

State

Postcode

Country

First Name

Last Name

Position

Phone

Email

Details of Principal of Business

First Name

Last Name

Position

Phone

Email

Type of business

For which companies is your business an Authorised Representative of?

What Operating Systems (including System Type) do you use?

Please specify your type of broadband

Do you have a CISCO Router

Yes No Unsure

Please Specific CISCO Router's static IP

Number of PCs that require access to eBusiness Portal?

Number of PCs that require access to eBusiness Portal at the same time?

Do you have more than one office?

Yes No

Do you require access to eBusiness Portal from more than one office?

Yes No

Please indicate which Sunrise insurers you wish to transact business with on the eBusiness Portal. Note, Upon receiving the completed application Ebix will make contact with each chosen insurer. However, it is essential that your company also discuss your requirements directly with your insurer representatives.

Are you a member of any of the following groups?

Austbrokers National Insurance Brokers Association (NIBA) Insurance Advisers Association of Australia (IAAA) Australasian Association of Insurance Brokers (AAIB) Council of Queensland Insurance Brokers Inc. (CQIB) Steadfast Insurance Brokers Management Group Ltd Underwriting Agencies Council (UAC) NA

Please Specify

Further Information/Comments

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I agree to the Privacy Policy

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Ebix eBusiness Portal Application Form Ebix eBusiness Portal Application Form

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