Pursuant to the Privacy Act 2020
To be completed by the Insured(s) shown and also on behalf of any other person covered by these insurances.
Your insurer is Berkshire Hathaway Specialty Insurance Company
I/We:
- Declare to the best of my/our knowledge and belief all information given to Star Insurance Limited (Star) who acts as agent for the insurer and/or any other party(ies) authorised by Star or the insurer to receive information from me in connection with this claim (whether this information is supplied orally or is written) is complete, true and correct and no information relevant to the claim is omitted.
- Agree to provide any further information that may be required by Star, the insurer or any other party(ies) authorised by Star or the insurer to receive information and/or to process this claim.
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Authorise the disclosure of this information to other parties, including parties with a financial interest, private investigators, crown authorities, advisors, repairers or parties involved in replacing the subject matter of this claim.
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Authorise the obtaining personal information about me/us that is in Star and/or the insurer and/or any other party(ies) authorised by Star and/or the insurer to process this claim view as relevant to this claim.
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Understand that I am/we are entitled to have certain rights of access to and correction of the personal information held by Star and/or the insurer and/or any other party(ies) authorised by Star and/or the insurer to process this claim.
The information in this claim is complete, true and correct and no information relevant to the claim is omitted
