Zurich PRSA Forms

Application form for you to complete and scan to john.geraghty@labrokers.ie and cc jennifer.donnellan@zurich.com or post to LABrokers Ltd, Newcastle, Greystones, FREEPOST FGSS10, Co. Wicklow.

Please ignore this form if payment is being made via your own personal bank account. If your employer facilitates deduction of premiums from your salary please request your employer to complete this ‘Letter of Appointment’ and scan it back to Zurich per instructions on letter above.