Please note:
Any occurrence or claim must be notified to Clarity Insurance Brokers immediately.
You must not incur any expenses without the written consent of your insurer.
You must not make any admission of liability, offer of settlement, promise or payment without the written consent of your insurer.
Failure to provide full and correct information could result in your claim being delayed or not being accepted by your insurer.
Please retain damaged goods in case inspection is required.
Please attach estimates in support of repairs as appropriate along with any other relevant documentation.
Claim form declaration
I/we declare that to the best of my/our knowledge the information provided in this form is complete and accurate.
I/we:
Agree to provide any further information that may be required;
Understand that you require this personal information in connection with this claim and that it may be stored physically or electronically by Clarity Insurance Brokers, or any supplier (with whom we have a contractual arrangement);
Authorise the disclosure of this personal information associated with this claim to other parties;
Authorise you to obtain from any other party personal information about me/us that you may consider to be relevant to this claim;
Authorise you to add details of this claim to the database of the Insurance Claims Register (ICR) where it will be retained and available for other insurers to access;
Authorise you to obtain from the ICR details of claims made by me/us;
Understand that I/we have certain rights of access to and correction of personal information held by you and the ICR;
Understand that failure to provide all personal information requested by my insurer in relation to this claim may result in the claim being delayed or denied.
