Mainstay Underwriting Connection Request

Fill in the information below to request a connection to a Mainstay Underwriting product on Sunrise Exchange®

What is your Sunrise ID? (Please contact support@ebix.com.au if confirmation is required)

Do you have an Underwriting Agency agreement with Mainstay? (If No, please call Mainstay on 07 5680 9945 to discuss. Please also continue with this form).

Yes

No

Business/Company name?

What is your company address?

What is your company ABN?

Are you an AR of another company? If so, what is the main company name?

Primary contact?

Primary contact email address?

What Broking System do you use?

Please indicate which product from Mainstay Underwriting you wish to transact business with on Sunrise Exchange®

Mainstay Trades (MTRADES)

Have you discussed this connection request with the Insurer?

If yes, who did you speak to?

Any other information Ebix should know?

Mainstay Underwriting Connection Request

NAVIGATION

CONTACT

Mainstay Underwriting Connection Request

Success!