Life Insurance Quote

Complete the form below to be sent a quote through to your email.

GENERAL DETAILS

Do you currently have any Insurance, KiwiSaver or Home Loans through AMP?

If you already have an existing life insurance policy and want to make changes to it please fill in the form on Contact page or contact us. (0508 85 86 87)

No, I'm new to AMP

Insurance - Life, Income or Health

Insurance - Domestic, Commercial or Farm

KiwiSaver

Home Loan

If yes, Who is your AMP Adviser

To be insured

Name

First Name

Last Name

Gender

Date of Birth

e.g. 19/08/1990

Smoker Status

Level of Cover

Have any dependents?

Secondary/Partner to be insured

If required - otherwise leave blank

Name

First Name

Last Name

Gender

Date of Birth

e.g. 19/08/1990

Smoker Status

Level of Cover

Contact Details

Name - If different to person to be insured

First Name

Last Name

Email Address

Contact Number

Address

Additional Information

Disclosure statements for Advisers are available on request and free of charge