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Get New Customer Authorisation Form - Aviva - Amii Org 2026

The Customer Authorisation Form is designed for customers to authorize their health insurance provider regarding the selection or change of an intermediary for policy advice. It offers two options: a market review without transferring the policy or a full transfer to a new intermediary. Customers must complete their details, confirm understanding of the options, and provide signatures. The form also includes guidance for intermediaries on its completion and submission.

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Click ‘Get Form’ to open it in the editor.
Begin with Option 1 or Option 2. If you choose Option 1, indicate whether you wish to conduct a market review without transferring your policy by ticking the appropriate box.
Fill in the effective date and provide your signature along with your job title if applicable.
If opting for Option 2, confirm the transfer of your policy by ticking the relevant box and entering the effective date. Sign and include your job title if necessary.
In Section 3, complete your customer details including insurance company, policy number, full name, group name, postcode, and date.
Finally, Section 4 requires intermediary details. Ensure that both you and the intermediary sign this section after discussing the options.

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2021	4.8 Satisfied (45 Votes)
2016	4.2 Satisfied (50 Votes)

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