Your Privacy

Direct Marketing "Opt-Out" Form

This form must be completed by the person who currently receives correspondence from any company of the Allianz Group. If you have more than one policy with the Allianz Group please list all policy numbers on this form.

If you need any assistance please call the Allianz Direct Marketing Privacy Service Line - Freecall 1800 000 284 EST 9am-5pm, Mon-Fri.

All fields marked with an asterisk (*) are required.

Customer Details
Title:
First Name: *
Middle Initial:
Surname: *
Address, Email Address & Telephone Details
Property Name: (if applicable)
Level:
Unit No:
Address Type: *
Number: *
Street Name:
(only required if address type is Street Number)
Town / Suburb: *
State: *
Postcode: *
Daytime Contact Number: (eg. 0295554444 or 0400111222)
Email address (enter "none" if not applicable): *
Policy Details
Policy Number 1: *
Policy Number 2:
Policy Number 3:
Policy Number 4:
Policy Number 5:
Information Source
Which communication from us are you referring to? *
Cancel