Authority to Release Information
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I, , hereby authorise Avant Insurance Limited (ABN 82 003 707 471) to provide confirmation of my indemnity insurance to .
The information provided may include the following details:
- Name
- Address
- Avant Member ID
- Policy Number
- Policy Start and End dates
- Policy Limit
- Category of practice
- State of practice
This authorisation will continue indefinitely or until revoked myself.
Avant Member Authentication
As an added security measure we require you to enter a security code. This code will be sent to the mobile number we have on record for you, which ends in .
If this number is not correct or up to date, you can update your details via the Avant Member Portal or by calling us on 1800 128 268 during business hours. Once updated please resume your authorisation process on the following day
Name:
Security Code:
Consent provided
Thank you for authorising Avant Insurance Limited (ABN 82 003 707 471) to provide confirmation of your indemnity insurance to
Consent not provided
You have selected not to authorise Avant Insurance Limited (ABN 82 003 707 471) to provide confirmation of your indemnity insurance to .
Unsuccessful Authentication
The maximum number of failed attempts has been reached. If you would like to complete the authorisation process you can do so by contacting us on 1800 128 268 during business hours.