Welcome to Max Insurances
0800 ASK MAX (0800 275 629)
D1, 27-29 William Pickering Drive,
Phone 0508 629 5626
Tel: 09 913 3011
Fax: 09 913 3012
Date of Birth
Do you have existing insurance
If your answer is 'Yes', can you tell us the insurance company name and your customer & policy no.
Have you made any claims in the past 12 months
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.