If you would like to become a wholesale agent and provide this product to your client base, please complete and submit the form below. A Landcover representative will be in contact shortly. Contact DetailsName* First Last Business Name*Select your Business nameAustralian Insurance SolutionsAviso EIABe Sure Insurance SolutionsCerberos Brokers Pty LtdCommunity Broket Network - Insurance Agents Group (IAG) Pty Ltd t/as Insurance TimeCommunity Insurance Solutions (Part of the CBN Network)Cutting Edge Insurance BrokersGallagherGeelong Insurance BrokersGeneral Insurance Brokers of AustraliaKeystone InsuranceLinx Insurance AustraliaManaged Insurance SolutionsMethod Insurance Brokers (CBN)MIS Insurance BrokersPhoenix Insurance BrokersPrelis Insurance Solutions Pty Ltd (Authorised Representative of PSC Connect Pty Ltd)PSC Insurance Brokers (Darwin)PSC Insurance Brokers (Perth)RMH Insurance Services Pty LtdShielded Insurance BrokersSIMEONE Pty LtdSK Insure Pty LtdWest Insurance BrokersRaywhite PaddintonHiddenBusiness Name - old Email Address* Confirm Email* Mobile Phone Landline Street AddressAddress* Street Address Suburb State Select StateAustralian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia Postcode Postal AddressPostal Address Same as Street Address Address Address 1 Suburb State Select StateAustralian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia Postcode AFS LicenseDo you hold an AFS license?* Yes No AFS License #* Do you belong to any cluster group?*NoSteadfastIBNAAustbrokersOtherPlease list To arrange this insurance on behalf of your client you agree to the following conditions and you will advise your clients accordingly: There is no refund of premium or fees paid in the event of cancellation Gross premium payment is required to activate the cover by using a credit card. Commission you earn will be paid on a monthly basis at a flat rate of $20 including GST per policy. Expiry advice will be advised by way of email to you prior to the expiry date. Therefore, no hold covered arrangements apply and if continuity of cover is required a new contract for 12 months would be required. Username* Password* Enter Password Confirm Password Strength indicator Affiliate ID