Does your Brokerage want to work with us? Compete the form to sign up today!

• This form must be completed by a Director or Officer of the Company.
• To avoid delays please remember that incomplete or incorrect applications will be returned to you.
• Please note the completion of the application does not commit Berkley Insurance Australia to granting a Broker Agreement.
• Berkley Insurance Australia reserve the right to refuse this application without giving any reason or explanation.

We can confirm that to the best of our knowledge and belief, and having undertaken appropriate enquiries, the information contained in this application form and any attachments hereto, is correct. We understand that any false or misleading information provided in this application form or any attachments hereto, may lead to the termination of the firm’s broker agreement. We undertake to advise Berkley Insurance Australia of any changes to the information contained herein, that are brought to our attention.