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.

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

Please note: This form is for Requesting insurance refunds only.

If you need to make an Insurance claim, please click here.

If you would like to Request new insurance, please click here.
- Please enter your contact details.
- Enter your name
  Enter first name / last name.
- Select your role
- Enter your phone number
- Enter your email address
- Select your Kōhanga Reo
- Select your Rohe
- Select insurance type(s) you are seeking a refund for
- 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
- 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
- Insurance not required, have separate cover: 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
- 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’.
- No longer in building: 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
- 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'.
- No longer lease or own waka: 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
- 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'.
- Sundry: 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
- 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
- I {enterYour234} confirm that:
- 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.
- Should be Empty: