Contact Permission Form

By completing and submitting this form, you, the agent, are giving First Insurance Company of Hawaii permission to contact the policyholder directly regarding First Insurance Company of Hawaii services, with the understanding that you will be included on all correspondence only if your contact information is submitted on this form.

If you have questions regarding this form, please contact

Agent Information

(eg. 8085551234)

Policy Holder Information

Main Contact

(eg. 8085551234)