Update My Details

Name: Surewise
Address: PO Box 6095 Halifax Street, Adelaide, 5000, SA
Telephone: 1800 273 256

This page provides clients of SUREWiSE with an online option to request updates and changes to the contact details we hold on file for them.

Any information or requests relating to a change to an insurance policy will not acted upon using this form. To request a change to your insurance policy, you are required to contact your Account Manager or contact our office on 1800 273 256.

Update My Details

Update My Details Request Form

Client Code*
Enter your unique client code (refer to your invoice)
Requesting changes to your contact details
To request a change to the contact details we hold on file for you, only complete the details you want updated.
Business Name
Enter your business name (if applicable)
Postal Address
Enter your postal address

Street or Post Office Box Address Line 2 City State Post Code Country
Website
Enter your website address
Main Email Address
Enter your main email address
Enter Email Confirm Email
Main Phone Number
Enter your main phone number (including area code)
Main Fax Number
Enter your main fax number (including area code)
Specifying a Primary Contact Person
You can nominate up to two contact persons on this form for your insurance policies. You can specify a primary contact person and a secondary contact person. This section of the form allows you to specify your primary contact person.
Primary Contact Person
Enter the primary contact person's first name, surname and job title
First Name Surname Job Title
Primary Contact Person's Date of Birth
Enter the primary contact person's date of birth
MM slash DD slash YYYY
Primary Contact Person's Email Address
Enter the primary contact person's email address
Enter Email Confirm Email
Primary Contact Person's Phone Number
Enter the primary contact person's phone number (including area code)
Primary Contact Person's Fax Number
Enter the primary contact person's fax number (including area code)
Primary Contact Person's Mobile Phone Number
Enter the primary contact person's mobile phone number
Specifying a Secondary Contact Person
You can nominate up to two contact persons on this form for your insurance policies. You can specify a primary contact person and a secondary contact person. This section of the form allows you to specify your secondary contact person. If you wish to nominate additional contacts, please contact our office.
Secondary Contact Person
Enter a secondary contact person's first name, surname and job title
First Name Surname Job Title
Secondary Contact Person's Date of Birth
Enter the secondary contact person's date of birth
MM slash DD slash YYYY
Secondary Contact Person's Email Address
Enter the secondary contact person's email address
Enter Email Confirm Email
Secondary Contact Person's Phone Number
Enter the secondary contact person's phone number (including area code)
Secondary Contact Person's Fax Number
Enter the secondary contact person's fax number (including area code)
Secondary Contact Person's Mobile Phone Number
Enter the secondary contact person's mobile phone number
Additional Information
This section of the form allows you to provide us with any additional information regarding changes to your contact details.
Enter any additional information regarding changes to your contact information. Changes required to an insurance policy will not be acted upon using this form - you are required to contact your Account Manager or contact our office.
Enter any additional information regarding changes to your contact information. Changes required to an insurance policy will not be acted upon using this form - you are required to contact your Account Manager or contact our office.
Who has completed this form?
This section of the form captures information about the person completing this form. You must be an authorised person in order for changes to be considered and/or made.
Name of Authorised Person*
Enter the first name, surname and position title of the authorised person who is requesting the changes specified above
First Name Surname Job Title
Authorised Person's Email Address*
Enter the email address of the authorised person requesting the above changes
Enter Email Confirm Email
Authorised Person's Phone Number*
Enter the phone number (including area code) of the authorised person completing this form
Authorisation & Declaration*
By ticking the box below, you declare that you are authorised to request the contact information changes specified above which relate to the specified client code only. You also agree and acknowledge that any changes requested above will not be made to any insurance policy. If you require changes to be made to an insurance policy (including risk addresses) you must contact your Account Manager or contact our office. All changes requested on this form are for client contact details only.
- YES - I am authorised to request the above changes
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Comments
This field is for validation purposes and should be left unchanged.

Update My Details

Update My Details Request Form

Requesting changes to your contact details

Specifying a Primary Contact Person

Specifying a Secondary Contact Person

Additional Information

Who has completed this form?

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