By completing this form you confirm that you have read the BRIC Privacy Policy available on our website (www.bric.com.au) or on request and you authorise and consent to BRIC collecting, holding, using and disclosing any personal information related to your application for insurance in accordance with those terms, including for the purposes explained and to the persons and authorised third parties identified. You may modify or withdraw your consent at any time. If you do not give us consent or subsequently modify or withdraw your consent, we may not be able to provide you with the products or services you want.