Insurance - Customer Callback

Branch Details

Customer Details

Insurance Policy Details

* Renewal date filed may only be left blank in instances where the customer is taking a Home or Car Policy for the first time.

Consent to Communicate


Legal Disclaimer (to be read to customer by AIB Staff)

Allied Irish Banks, p.l.c. is an agent of AIB Insurance Services Limited for the provision of General Insurance products. AIB Car and Home Insurance is exclusively underwritten by AXA Insurance dac. AIB Insurance Services Limited is regulated by the Central Bank of Ireland.

Data Protection Statement (to be read to customer by AIB Staff)

In order for us to provide a referral to AXA to provide or discuss a quote for AIB Car/Home insurance, we need your consent to share your personal data and any other relevant information you have provided in this referral form with the AIB Insurance team in AXA. If you would like to discuss the nature of this consent or withdraw your consent, you can contact us at 01 4711 820.

AIB Staff Confirmation

  1. I confirm that I have informed the customer they will receive a call from the AXA number 01 4711 820
  2. I confirm that I have read the Data Protection statement to the customer and verbally obtained and recorded AIB Customers consent on Client View for their contact details to be submitted to AXA.
  3. I have advised the customer that if they would like to discuss the nature of the consent given or withdraw consent, they can contact their branch.
  4. I have notified the customer that AXA and AIB will exchange information relating to the referral and information relating to any formal complaint the customer might make. 

Click submit ONCE and wait for the ‘thank you’ message. This could take up to 10 seconds or more to appear.