Brokers Investigation Form

Please complete this form and your Brokersure representative will be in contact with you shortly

Brokers Investigation

Brokers Investigation

I/We hereby appoint Brokersure Insurance Group
To investigate any/all my insurance policy/policies
Brokersure Insurance Group may obtain any information pertaining to my/our insurance.
Your co-operation in providing the relevant information would be greatly appreciated.
Risk Address
Risk Address
City
Province
Postal Code
Is the postal address different from the risk address?
Postal Address
Postal Address
City
Province
Postal Code
By signing this I authorise Brokersure to obtain all the relevant information pertaining to my insurance and understand that my current advisor may be informed that this letter has been signed.