NIBAU Application to Join the Partner Network

* Please DO NOT use CAPS LOCK to fill out this form

Enter Agency details

Agency Trading Name *

Legal Entity for Agency *

Australian Business Number (ABN) *

Main Agency Contact - First Name *

Main Agency Contact - Last Name *

Agency Address

Address Line 1 *

Address Line 2

Suburb *

State *

Postcode *

Country *

Office Email *

Phone Number

Website URL

+ Download Direct Debit Form

To set up Direct Debit Payments, download the form and submit to travelaccounts@nib.com.au for processing.

Add Multiple Consultant Details

Register your consultants so they can access our products, training and agency portal. NB: For each consultant please provide their name and individual email address.

Consultants First Name*

Surname*

Email*

Actions

No users have been added, please use the buttons below to add more.

Bank Details

Finance Contact - First Name *

Finance Contact - Last Name *

Finance Contact Email *

Company Account Name *

Bank Name *

BSB Number *

Account Number *

 Partner Application

Enter Agency details

Agency Address

Add Multiple Consultant Details

Bank Details

Agreement to Distribute and Terms