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Insurance Application Form

I acknowledge that:

  1. I/we have requested information about insurance products or services through Provincial Insurance Brokers
  2. I/we have been referred to Provincial Insurance Brokers by WBS;
  3. WBS may receive a commission payment from Provincial Insurance Brokers in respect of my/our purchase of any such insurance products or
    services and I/we consent to any such commission payment being made to WBS;
  4. WBS will not, other than the information contained on this form, share any of your personal information with Provincial Insurance Brokers,
    without my/our prior consent. WBS manages your personal information in accordance with its Privacy Policy

About Provincial Insurance

When you think insurance, not many companies stand out from the crowd. But we do!

Since 1993, Provincial Insurance has been there to help commercial and rural clients in the Wairarapa and Wellington region take care of all their insurance needs while they get on with looking after business.