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On-demand Insurance Solutions

 

Step 1 of 7

Sunrise Exchange Application Form
  1. Company Details
  2. Company Name*
    Required
  3. Trading as
    Invalid Input
  4. ABN*
    Required. Invalid Input.
    Enter your ABN here without spaces. Eg: 70061035167
  5. ACN
    Required.
    Enter your ACN here without spaces. Eg: 123456789
  6. Company Phone*
    Required
  7. Company Fax
    Invalid Input
  8. Company Website
    Invalid Input
  9. Company Email
    Invalid Input
  10.  
  1. Company Street Address
  2. Address Line 1*
    Required
  3. Address Line 2
    Invalid Input
  4. City/Suburb*
    Required
  5. State*
    Required. Select State from dropdown.
  6. Postcode*
    Required
  7. Country*
    Required
  8. Company Postal Address
  9. Same as Company Street Address?
    Invalid Input
  10. Address Line 1*
    Required
  11. Address Line 2
    Invalid Input
  12. City/Suburb*
    Required
  13. State*
    Invalid Input
  14. Postcode*
    Invalid Input
  15. Country*
    Required
  16. Company Billing Address
  17. Same as Company Postal Address?
    Invalid Input
  18. Address Line 1*
    Required
  19. Address Line 2
    Invalid Input
  20. City/Suburb*
    Required
  21. State*
    Invalid Input
  22. Postcode*
    Invalid Input
  23. Country*
    Required
  24.  
  1. Details of Primary Contact
  2. First Name*
    Please type your first name.
  3. Last Name*
    Please type your last name (surname).
  4. Position*
    Please enter your position/role.
  5. Phone*
    Invalid Input
  6. Email*
    Required.
    A confirmation of this application will be sent to this email address for reference.
  7. Details of Principal of Business
  8. Same as Primary Contact?
    Invalid Input
  9. First Name*
    Please type your first name.
  10. Last Name*
    Please type your last name (surname).
  11. Position*
    Please enter your position/role.
  12. Phone*
    Invalid Input
  13. Email*
    Required.
  14.  
  1. Company Type
  2. Type of business*



    Required
  3. For which companies is your business an Authorised Representative of?*
    Invalid Input
    List all applicable here.
  4.  
  1. System Details
  2. What Operating Systems (including System Type) do you use?*
    Invalid Input
    eg: Windows 7 Professional 32bit
  3. What type of broadband do you use?*
    Required
  4. Please specify your type of broadband:*
    Required
  5. What Broking System are you currently using?*
    Required
    eg: CBS, eGlobal, WinBEAT, BrokerPlus, BrokerAdvantage, Custom
  6. Do you have a CISCO Router*
    Required.
    Having a CISCO Router is not a requirement for using Sunrise Exchange.
  7. Please Specific CISCO Router's static IP*
    Invalid Input
    eg: 127.0.0.1
  8. MS Internet Explorer Version?*
    Required. Enter integer value.
    Eg: 6, 7, 8 or 9 etc
  9. Adobe Acrobat Version?*
    Required. Enter integer value.
    Eg: 6, 7, 8, 9 or 10 etc
  10. Number of PCs in this office?*
    Required. Enter integer value.
  11. Number of PCs that require access to Sunrise Exchange?*
    Required. Enter integer value.
  12. Number of PCs that require access to Sunrise Exchange at the same time?*
    Required. Enter integer value.
    Number of concurrent users required for Sunrise Exchange.
  13. Branches
  14. Do you have more than one office?*
    Required
  15. Do you require access to Sunrise Exchange from more than one office?*
    Required
  16. You have indicated that you require access to Sunrise Exchange from more than one location. Details of each branch location are required to set up the various connections. These details can be submitted in a separate "Branch" form accessible after completing this form. This "Branch" form will need to be filled out for each and every location that requires access to Sunrise Exchange.
  17. Do you operate a separate ledger on your broking system for each branch?*
    Required.
  18. Do you require access to Sunrise Exchange for EACH branch location?*
    Required.
  19.  
  1. Insurers
  2. (1) Please indicate which insurers you wish to transact business with on Sunrise Exchange
    (2) Also indicate whether you have an agency with the respective insurer
    (3) Lastly, indicate if you have discussed connection to Sunrise Exchange with that insurer
  3. AIG
    Invalid Input
  4. Allianz
    Invalid Input
  5. CGU
    Invalid Input
  6. Chubb
    Invalid Input
  7. Club Marine
    Invalid Input
  8. HCI
    Invalid Input
  9. Hollard
    Invalid Input
  10. NTI
    Invalid Input
  11. QBE
    Invalid Input
  12. SGUAS
    Invalid Input
  13. TravelCard
    Invalid Input
  14. Vero
    Invalid Input
  15. Zurich
    Invalid Input
  16.  
  1. Other
  2. Are you a member of any of the following groups?








    Invalid Input
  3. How did you find out about Sunrise Exchange?







  4. Please Specify
    Invalid Input
  5. Further Information/Comments
    Invalid Input
  6. Captcha
  7. Privacy Policy*
    Your understanding and acceptance of our Privacy Policy is required before proceeding.
  8.   
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