Cancellation Request - Shielded Insurance Brokers

Policy Cancellations

To submit a policy cancellation request please use the form below. Be sure you are aware of the terms and conditions of canceling before submitting the request.

Full Name *

Email *

Contact Number *

Policy Number (If Known)

BSB and Account Number (For Refunds)

Policy Cancellation Date (Date for cancel to be in effect)

Reason for cancellation *

Please sign

IMPORTANT: When a policy is canceled midterm we retain any income we earn as brokers. If you are on monthly payments, you are still liable for the interest portion on the monthly payment contract. This will leave you with a shortfall that will need to be paid back to the funder. We do not know how much this amount is until we process your cancellation request.