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
Contact Number
Your Email
Loan Type CCILPI
Do you have existing insurance YesNo
Total Loan Amount (including all loan set-up fees) $
Loan Term (months)
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