Request insurance refund form

Request insurance refund form

Use this form to request a refund of an insurance premium.
Please note: If your request for a refund is approved, the actual amount refunded will be determined based on a range of criteria.

This includes the:
- amount of time in the last year the insurance was valid
- timeliness of changes being notified to the Trust.
Before you begin

Please have a look through this form to see what information and documentation you will be required to provide. This varies depending on your reason for seeing a refund. Gather this information before you start completing the form.

Whānau hui minutes confirming the refund request are required to be attached before you submit your request.

We'll process your application as soon as possible and will be in touch.

Your insurance
Select insurance type(s) you are seeking a refund for*

BuildingContentsPublic liabilitySundry – eg for small sheds etc. on propertyWaka

Your refund request
Select reasons for refund from the options below. *
Insurance not required as have separate cover
No longer in building
No longer lease or own waka (eg vehicle has been sold or disposed of or written off)
No longer have sundry eg shed on property
Other

Insurance not required as have separate cover
What asset do you not require cover for?*
Please describe the item so we can identify the correct policy.
Who is your insurance provider?*
Please state the provider if known, or identify that the insurance is managed via the landlord if you don’t know.
What is the amount of cover you have?*
What date did the cover start?*

DayMonthYear
What amount are you seeking a refund for?
Please enter an amount if you know what this might be and add comment if required.
Comment
Please upload your policy document if available

Please upload or drag and drop your files here
Acceptable file types are: pdf, jpg, jpeg, png, gif. Cancelof

No longer in building
When was your last day in the building?*

DayMonthYear
Date
Enter your new permanent or temporary location as applicable

Street Address

Suburb

City

Post code
Is this a temporary relocation?*
Duration for temporary location*

DayMonthYear
Please indicate the expected duration to stay at the temporary relocation.
Do you have insurance cover for the new address?*
Is the insurance through the Trust or another provider?*
Please upload your policy document if available

Please upload or drag and drop your files here
Acceptable file types are: pdf, jpg, jpeg, png, gif. Cancelof
What date did you notify the Trust of this change in location?*

DayMonthYear
If you have not previously notified the Trust, leave date as today.
Who did you notify?*
Please enter the name of the person informed or the email address used, or enter ‘no-one notified’.
What amount are you seeking a refund for?
Please enter an amount if you know what this might be and add a comment if required.
Comment
Please upload your written notification to the Trust (copy of email or letter)

Please upload or drag and drop your files here
Acceptable file types are: pdf, jpg, jpeg, png, gif. Cancelof

No longer lease or own waka
Was the waka owned or leased?*
Enter the date of disposal/sale*

DayMonthYear
Enter sale price $*
Please upload proof of deregistration*

Please upload or drag and drop your files here
Acceptable file types are: pdf, jpg, jpeg, png, gif. Cancelof
What date did you notify the Trust of this waka change?*

DayMonthYear
If you have not previously notified the Trust, leave date as today.
Who did you notify?*
Please enter the name of the person informed or the email address used or enter ‘no-one notified'.
What amount are you seeking a refund for?
Please enter an amount if you know what this might be and add a comment if required.
Comment
Please upload your written notification to the Trust (copy of email or letter)

Please upload or drag and drop your files here
Acceptable file types are: pdf, jpg, jpeg, png, gif. Cancelof
Do you have a replacement waka?*
What's the waka number plate?
Has the Trust been informed of the new waka?*
Is the insurance through the Trust or another provider?*
Please upload your policy document*

Please upload or drag and drop your files here
Acceptable file types are: pdf, jpg, jpeg, png, gif. Cancelof
Please upload your sales and purchase agreement for the new waka*

Please upload or drag and drop your files here
Acceptable file types are: pdf, jpg, jpeg, png, gif. Cancelof

No longer have sundry
What sundry items(s) do you no longer have?*
Please describe the sundry item(s) so we can identify it on the policy, eg Shed 15m, front of property.
Was the sundry item removed from premises intact, or dismantled?*
If the item was sold, please state the sale price $*
If it was given away at no cost enter $0.
Enter the date of removal or when cover was no longer required*

DayMonthYear
What date did you notify the Trust of this change in sundries?*

DayMonthYear
If you have not previously notified the Trust, leave date as today.
Who did you notify?*
Please enter the name of the person informed or the email address used or enter ‘no-one notified'.
What amount are you seeking a refund for?
Please enter an amount if you know what this might be and add a comment if required.
Please upload your written notification to the Trust (copy of email or letter)

Please upload or drag and drop your files here
Acceptable file types are: pdf, jpg, jpeg, png, gif. Cancelof

Other
Please describe your other reason for requesting a refund*
What amount are you seeking a refund for?
Please enter an amount if you know what this might be and add a comment if required.
Please upload any relevant documentation

Please upload or drag and drop your files here
Acceptable file types are: pdf, jpg, jpeg, png, gif. Cancelof

Declaration and submit
I {enterYour234} confirm that:
I am seeking refund of the insurance premium(s) for valid business reasons.
All information is true and correct.
I have approval from our whānau to request this refund.
Please upload whānau hui minutes that support this request*

Please upload or drag and drop your files here

Cancelof
Enter any final comments
Please enter any extra comments.
Important note: Please remember to notify your accountant of the asset changes.

Review the form to ensure you have completed all relevant fields and attached all requested documentation, then click Submit.
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