HOUSE AND CONTENTS CLAIM FORM

Issuance of this form is not to be taken as an admission of liability

Your Details
Full name:*
Address:*
Contact details:
Postal Address:
Telephone
Work:
Home:
Mobile:
Email:
CLAIM DETAILS
Date/time of loss*
Location of loss*
How did the loss happen? (Please provide full details)*
Who caused the loss? Please provide names and addresses (if known).
If yes, please advise :
Date reported
Complaint reference number
Name of the Police Officer
DETAILS OF CLAIM
Description of item Where obtained Date Repair Cost Replacement Cost
         
         
         
         
         
If your property is lost or stolen, we may require proof of ownership. To assist in the settlement of such claims, could you please forward any receipts, credit card slips or other documents issued to you at the time of purchase.

If possible, keep damaged items available for inspection.

Willful or reckless exaggeration of the amounted claimed will end the policy, and the claim will not be paid.
YOUR PRIVACY
We collect and receive your personal information in this claim form to consider your claim. We hold it. You have rights to access it, and correct it under the Privacy Act 1993.

You must provide your relevant personal information to us to comply with the Claims Conditions of this policy. If you fail to do so, we may decline your claim.

We obtain your authority below to transfer your relevant personal information to other members of the insurance industry (including Insurance Claims Register Limited), financially interested parties noted on your policy, and repairers
YOUR DECLARATION
I declare that:
      1 All information given to New India in connection with the claim is true.
      2 No information relevant to the claim has been omitted.
      3 I authorize:
        3.1 New India to disclose this information to:
          3.1.1 Other members of the insurance industry (including Insurance Claims Register Limited), and
          3.1.2 Financially interested parties noted on the policy, and
          3.1.3 Parties repairing or replacing your property.
        3.2 The disclosure of my personal information held by any other parties to New India for the purpose of considering and administering the claim.