I, the undersigned, hereby authorize the TW Insurance Services Ltd., operating as Orbit Insurance Services, to act as my Broker and Adviser for my insurance needs, as specified below:

  1. Assessing my needs
    I agree to provide you with all information you require to meet my needs and underwrite insurance on my behalf, in accordance with my instructions.

  2. Representation
    I am the authorized representative of any other individual or organization covered under the policies you purchased on my behalf.

  3. Renewal
    You shall automatically renew policies underwritten on my behalf.

  4. Changes to the policy

    You may make changes to my policy when renewing it, if these changes are in my best interest and in compliance with the Law. If changing insurers, I authorize you to disclose my personal and payment information to the new insurer.

  5. Changes to the nature of the risk

    I shall advise you promptly of any change that may affect the insured risk. You shall let me know whether the risk is accepted by the insurer, and if it affects my premium.

  6. Appropriate amount of insurance
    I am responsible for having my property evaluated, as you have no expertise to do so. You shall purchase the amount of insurance that I request. I am aware that in some cases, even in cases of partial loss, underinsurance can result in proportional compensation.

  7. Payment and non-payment
    I agree to pay my insurance premium when it is due. You may, in case of non-payment, request on my behalf that my policy be cancelled, or advise the insurer that is it not required as it has not yet been written, as long as you send me a cancellation notice.

  8. Professional advice and fees
    You will provide me with free professional advice for the duration of the mandate. However I agree to pay reasonable administration fees if they're clearly indicated on my bill.

  9. Termination of mandate

    This mandate is for an indefinite period. It shall end when one of the parties notifies the other party in writing.

Contact Information

Name is required

Customer Number is required (6 digits)

Email is required

Employee Number is required

Policy Number is required

Phone number is required