Registration Form


We are committed to protecting your privacy. We use the information you provide to advise about and assist with your insurance and/or financial planning needs. We only provide your information to insurance companies, underwriting agencies, wholesale brokers, premium funders and other companies with whom you choose to deal (and their representatives). We do not trade, rent or sell your information.

If you don’t provide us with full information, we can’t properly advise you and you could breach your duty of disclosure. You can check the information we hold about you at any time. For more information about our Privacy Policy, ask us for a copy or visit our website www.ebm.com.au.

  • (required for security purposes)
  • (MUST be 6 characters, letters, numerals or a combination. Passwords are case sensitive.)

    By submitting this form I acknowledge that I will be provided with secure access to confidential information including insured details as well as systems and procedures not in the public domain. I agree not to divulge login details or any information contained therein, to any other person, company or party without the express written authorisation of EBM, except where I am required to do so in carrying out my responsibilities as an authorised user.

    I shall at all times take measures as may be necessary to protect the confidentiality of this information. Should my secure access details be compromised I agree to notify EBM as soon as possible so that the integrity of the system can be maintained.

    I further represent and warrant that I will not take advantage of this information for the benefit of myself or my company or to the disadvantage of EBM.