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Roderick Insurance Brokers

Update Your Contact Details

At RIB we are always happy to help,  you can update your details by phoning us or completing the online form below.

Don't have time to complete online? A printable version of the form is available here

Complete below and submit or print our PDF and :

  • Fax us on 03 5221 2521
  • Email to queries@roderick.com.au
  • Post to PO Box 701, Geelong VIC 3220

This form is to be used for change of Postal Address and Contact Details only. Acceptance of this form does not constitute acceptance of any changes to your existing cover.

 

All contact information is for our own records only and will not be used for any other purpose than for us to contact you regarding your insurance.  We take your privacy seriously, you must provide us with the following policy information before a change can be made to your details. Refer to our Privacy Disclaimer.

 

 

Roderick Ref
This appears on your invoice

Policy Number
This appears on your invoice

Postal Address


Postcode

Contact Person 1

* Insured or Relationship to Insured
* (Please tick the appropriate box) Mr Mrs Miss Ms Other (please state)

* First Name

* Surname

* Date of Birth
dd/mm/yyyy

Occupation

* Home Phone Number

 Work Phone Number
Mobile Phone Number
 * Email Address
 Fax Number
How would you prefer us to contact you? Phone Home Work Mobile Email Fax
Is there a time that you would prefer us to contact you? Yes (if yes please indicate)
No		 am
pm

Contact Person 2

Insured or Relationship to Insured
(Please tick the appropriate box) Mr Mrs Miss Ms Other (please state)

First Name

Surname

Date of Birth
dd/mm/yyyy

Occupation

Home Phone Number

 Work Phone Number
Mobile Phone Number
 Email Address
 Fax Number
How would you prefer us to contact you? Phone Home Work Mobile Email Fax
Is there a time that you would prefer us to contact you? Yes (if yes please indicate)
No		 am
pm

General Comments