Name
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If you remember, what date did you purchase your car/insurance?
-
Month
-
Day
Year
Date
If you remember, which add-on products were you sold?
Loan Protection Insurance (also referred to as “repayment insurance” or “consumer credit insurance”)
Motor Equity Insurance (also referred to as “guaranteed asset protection insurance”, “GAP insurance”, “shortfall insurance”, “purchase price insurance” or “value protect insurance”)
Extended Motor Warranty
Tyre and Rim Insurance
Other
Did you receive a Notice about this class action via email, text or post?
Yes
No
Your “Class Action ID” number
Submit
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