Claim Notification
Call us on 0800 11 2582
Claim Notification
Call us on 0800 11 2582
Please complete all relevant details. Fields marked with an asterisk (
*
) are mandatory.
Your duty
*
I have read and I make the declaration in the
declaration and privacy notice
Your details
*
Member/Client number
*
Policy number
*
Insured name
*
Date of birth (DD/MM/YYYY)
*
Address line 1
Address line 2
*
Post code
*
Suburb
*
Phone (incl. area code e.g. 09 555 6666)
Alternative phone (incl. area code e.g. 09 555 6666)
*
Email address
*
Your preferred contact method
Email
Phone
*
Have you or any other owner of the boat had any claim refused, insurance declined or special conditions imposed on any insurance policy in the last 5 years?
Yes
No
*
Have you or any other owner of the boat been convicted of any crime in the last 5 years?
Yes
No
*
Have you or any other owner of the boat been declared bankrupt and not discharged within the last 12 months?
Yes
No
*
Have you or any other owner of the boat ever suffered any fire, malicious damage or burglary claims on any previous insurance policy?
Yes
No
*
Have you or any other owner of the boat suffered any at fault marine claims in the last 5 years?
Yes
No
*
Have you, as owner, privately imported the boat from outside New Zealand?
Yes
No
