(Prairies) Aviva Credit Consent

Which form would you like to complete? (Once you complete a form and hit submit, you'll be given the option to select "complete additional forms" and return to this page)

Direct Deposit Details

Complete the payment authorization form with your current direct deposit information so that your monthly policy payments will continue to be made.
Name

First NameLast Name
Email
example@example.com
Policy Number (optional)
Bank Number
Normally 3 digits
Transit Number
Normally 5 digits
Account Number
Normally 7 digits
What day of the month do you want the withdrawals to be taken?

Credit Consent

Please complete this form so we can ensure you get the best available rate. Please note: This will authorize a soft check on your credit rating and WILL NOT affect your credit score. HUB International employees will have no access to this information.
Please confirm your information and provide your consent. If you have questions, please contact your broker or email us at prairies@hubinternational.com - thank you.
Name

First NameLast Name
Email
example@example.com
Policy Number (optional)
Date of Birth

MonthDayYear
Date
I authorize HUB International Insurance Brokers to collect and disclose my consent allowing an insurer to collect and use my personal credit information, including credit score, as permitted by law, for the purposes of obtaining the best available rate and coverages.

House Upgrades

Please complete if you have made any of the following updates to your house.
Name

First NameLast Name
Email
example@example.com
Policy Number (optional)
Select all that have been upgraded. You will be prompted to add information on the following page(s).

Direct Deposit Details