Club Marine Agency Nomination

Are you a Club Marine policy holder?

Club Marine will support Whitfords Sea Rescue by way of a donation for every policy holder that nominates Whitfords Sea Rescue as their preferred agency.

Please complete the form below today. Your premium is not affected and the commission we receive helps us provide this service.

Donations from Club Marine form a substantial part of our funding, please nominate us as your agent and encourage others to do the same.

Please note:

  • Your insurance premium is not affected
  • You still pay your premium directly to Club Marine
  • You do not need to fill this form in annually

Your Privacy

Your personal information will not be shared with third parties.
See our Privacy Policy for more information.

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Membership Information
First Name: *   Surname: *
Membership Number: Forgotten your Membership Number? Click here for help.
 
Contact Information
Email Address: *
Address (Line 1): *
Address (Line 2):
Suburb: *
State: *   Post Code: *
Contact Number: *
 
Club Marine Policy Details
Policy Number: *
Policy in Name Of: *
Policy Expiry Date: * (dd/mm/yyyy)
 
Confirmation