Sunrise Exchange ® Application Form Online Sunrise Exchange ® Application Form

Please Note, the following application form is for Sunrise Exchange ® via a Broking System. You will need to be using CBS, eGlobal, Evolution, eBusiness Portal, ibais, Insight or WinBEAT in order to apply for this access.

If you do not have one of these Broking Systems, please refer to ebix.com.au/products/sunrise/ebix-ebusiness-portal/

Company Name

ABN

Email

Address Line 1

Address Line 2

City/Suburb

Postcode

State

First Name

Last Name

Position

Phone

What Broking System do you use?

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 Sunrise Exchange?

Number of PCs that require access to Sunrise Exchange at the same time?

Desired Contract Start Date

Do you have more than one office?

Yes No

Do you require access to Sunrise Exchange for more than one office?

Yes No

Please note

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. Please indicate which insurers you wish to transact business with on Sunrise Exchange

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)

Please specify

Further Information/Comments

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