Welcome to Max Insurances
0800 ASK MAX (0800 275 629)
Phone 0800 ASK MAX or 0800 275 629
D1, 27-29 William Pickering Dr, Rosedale, Auckland, New Zealand, 0632
Tel: 09 913 3011
159 Jellicoe Street, Te Puke, Bay of Plenty, New Zealand, 3119
Tel: 07 850 9213
Your Name
Date of Birth
Your Address
Contact Number
Your Email
Do you have existing insurance YesNo
If your answer is 'Yes', can you tell us the insurance company name and your customer & policy no.
Have you made any contents claims in the past 12 months YesNo
Contents value (including contents in shed, garage and storage) $
Please let us know the details if you would like to specify some contents
Any other relevant information that may affect the insurance cover
Declaration: I/WE HEREBY DECLARE AND WARRANT that the answers given above are in every respect true and correct, and that I/We have not withheld any information within My/Our knowledge likely to affect the decision of the Company as to My/Our eligibility for insurance. This request and declaration shall be the basis of the quote request. YesNo