Pursuant to the Privacy Act 1993
To be completed by the Insured(s) shown and also on behalf of any other person covered by these insurances.
Declare to the best of my/our knowledge and belief all information given to Star Underwriting Agents Ltd t/a Star Insurance Specialists as agents of Vero Insurance Ltd (Star/Vero) and other parties authorised to receive information from me in connection with this claim (whether oral or 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/Vero.
- Authorise the disclosure of this information to other parties, including parties with a financial interest, private investigators, crown authorities, repairers or parties involved in replacing the subject matter of this claim.
- Authorise the obtaining personal information about me/us that is in Star/Vero’s view relevant to this claim.
- Authorise the obtaining of personal information in any way relevant to this claim from Insurance Claim Register Ltd (ICR)
- Authorise Star/Vero to place details of this claim on the database of ICR where it will be held and made available for other insurance companies to inspect.
- Understand that I am/we are entitled to have certain rights of access to and correction of the personal information held by Star/Vero and the ICR Ltd.
Please note: We gather information about you (including your claims history) to consider your claim. The terms of your insurance policy require you to supply this information, and if you do not provide it, or if you have provided any false or untrue information it might affect your rights under your policy with us. The entities referred to in this declaration/statement are; Star Underwriting Agents Ltd t/as Star Insurance Specialists, 15 Accent Drive, Manukau, Auckland, as agents of Vero Insurance NZ Ltd, Level 14, 48 Shortland Street, Auckland and the Insurance Claims Register Ltd. PO Box 474, Wellington.
The information in this claim is complete, true and correct and no information relevant to the claim is omitted