We appreciate you taking the time to get a quote with us. Unfortunately, based on our insurance criteria, we are only able to provide insurance for persons between the ages of 18 and 85.
If you think you made a mistake, you can contact us on 1300 83 5678. We are available from Monday to Friday, 8:30AM to 7:00PM (AEST) or email us at firstname.lastname@example.org
You may be able to find an alternate insurer for your needs here at www.findaninsurer.com.au or on 1300 728 228.
I hereby certify that the information given in the form is truthful, accurate and complete. No information likely to affect this claim has been withheld. I understand that this claim may be refused if information is untrue, inaccurate and concealed.
I authorise Velosure to give to, or obtain from other insurers or any insurance reference bureau, any information relevant to this claim or any other claim made by me on any insurance policy held by me.