PART B: CIRCUMSTANCES OF LOSS. PLEASE COMPLETE IN ALL CASES
Have you, within the past 5 years, made a claim against any Insurance Company?
Are you the sole owner of the property concerned?
If burglary, loss, or theft claim
Acknowledgement from attached,
DECLARATION: NOTE* Failure to provide full and truthful information could result in the Claim being declined.
1. I/We agree to The Company disclosing my/our personal information regarding this claim to:
(a) Other parties including other members of the Insurance Industry and the data base of the Insurance Claims Register (ICR Ltd) P.O Box 474, Wellington, where it will be retained and made available to other insurance companies to inspect (b) Parties who have a financial interest in the subject matter of the policy and parties repairing or replacing the subject matter of the claim. (c) I/We understand that I am/We are entitled to have certain rights of access to and correction of the personal information held by The Company and ICR Ltd.
2. I/We agree to The Company obtaining personal information about me/us that is, in The Company's view, relevant to this claim.
(a) From any other party including other members of the Insurance Industry and from Insurance Claims Register Ltd (ICR Ltd) which holds details of claims made by me/us under policies with other insurers.
3. I hereby declare that the answers give above are in every respect correct and I make the solemn declaration conscientiously believing the same to be true and by virtue of the Oaths and Declaration Act 1957.