WinBEAT Application Form Online WinBEAT Application Form

Company Name

Trading as

ABN

Company Phone

Company Fax

Company Website

Company Address Line 1

Company Address Line 2

Suburb

State

First Name

Last Name

Position

Phone number

Email

Type of Business

Registered Broker Authorised Representative Underwriting Agency

AFS License No:

Single User or Multi-User

Initial User Level Required

What system are you currently using? (if Applicable)

Desired Contract Start Date

Do you require a quotation for a conversion of your existing data?

Do you require a Sunrise Exchange connection?

Do you require a quote to convert your information to Sunrise Exchange?

Are you a member of any of the following groups?

Austbrokers National Insurance Brokers Association (NIBA) Insurance Brokers Network Australia (IBNA) Insurance Advisers Association of Australia (IAAA) Insight Australia Group Limited (IIBA) Council of Queensland Insurance Brokers Inc. (CQIB) Steadfast Insurance Brokers Management Group Ltd Underwriting Agencies Council (UAC) No

Please Specify

Privacy Policy

I agree to the Privacy Policy

Ledger Name

Banking Options

Not Applicable Automated Banking MPP NAB Transact

eLink

Policy Client eXpress

EDI Options

Sunrise Sunrise - Quoting Installments SmartOffice

Number of users

iClose

iClose - Accounting iClose - Policies iClose - Claims

Thank you for choosing WinBEAT for your back-office system.

For your application status contact the WinBEAT team at 03 9895 2600 or free call 1800 807 139 outside the Melbourne metro area, or alternatively email winbeat@ebix.com.au. Please allow 5 – 7 working days for processing.

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