GSK Contact Information

Paul Icanovski - Account Manager
Phone - (08) 9478 1933
Fax - (08) 9478 3124

Printed Forms

Proposal Form

Direct Debit Form

Insured Details

THIS FORM IS ONLY FOR USE IF YOU REQUIRE AN INSURANCE PACKAGE. SHOULD YOU ONLY REQUIRE A QUOTATION PLEASE CONTACT OUR OFFICE ON 9478 1933.


Courier Company *
Name of Courier Company
Insured Name *
Date of Birth *
Address *
Suburb *
State *
Postcode *
Home Telephone *
Mobile Number
   
Are you registered for GST? *
ABN
   
Email Address


Cover Required



Motor Vehicle Cover *
Personal Accident & Sickness Cover *
Public Liability *
Goods / Cargo Cover *

* Denotes Mandatory Information