|Date of Birth*|
|Parent or guardian*|
|Date of loss|
|Where the loss occurred*|
|Were the police notified*||
|( If Yes please attach Police Acknowledgement Form )|
|When an item has been stolen this must be reported to the police and a Police Acknowledgement Form is required|
|Describe in detail*|
|how the loss or*|
|Relating to this loss*|
|Detail any other insurance*|
|Detail any other person invloved*|
|Detail previous insurance claims*|
|Declaration/ Privacy Act 1993 / Insurance Claims Register|
|I/We declare that to the best of my/our knowledge and belief these particulars are complete and correct.
(a) agree to give any further information that may be required;
(b) understand you require this personal information , which will be retained by you at Level 2, 12-14 Northcroft St Takapuna before you can evaluate my/our claim;
(c) authorise the disclosure of this personal information regarding this claim to other relevant parties;
(d) authorise the obtaining by you from any other party personal information about me/us that is in your view relevant to this claim;
(e) authorise the obtaining by you from Insurance Claims Register Limited (ICR Ltd), which holds details of claims made by me/us under policies with other insurers, personal information about me/us that is in your view relevant to this claim;
(f) authorise you to place details of this claim on the database of ICR Ltd, PO Box 474, Wellington, where it will be retained and be available to other insurance companies to inspect;
(g) understand that I am/we are entitled to have certain rights to access to and correction of the personal information held by you and ICR Ltd.
The collection of this information is required under the terms of your policy. Failure to provide it may result in your claim being declined.
|Signature of the policyholder(s) (If the policy is in joint names, both signatures are required)|
Crown Insurance is a leading provider of consumer finance insurance and warranty insurance solutions.
The company has a clear mission. Firstly through training to professionalise the "Point of Sale" consumer finance and insurance industry and secondly, to take the risk out of buying cars and other major consumer goods for New Zealanders.
Through its affiliates, Crown is able to offer both retail companies and financiers proven mechanisms to build their finance business, provide quality insurance products and maximise profits from the provision of financial services. Training and support through seminars, in-house training modules and ongoing performance monitoring are tailored to individual client requirements.
CONSUMER PROTECTION INSURANCE
To compliment its business in the financial services market, Crown has products designed to protect consumers against unexpected loss of their financed assets.
EXTENDED WARRANTY PROGRAMMES - AUTOMOTIVE
Crown currently administers programmes for a number of manufacturers, dealer groups and finance partners involving a broad range of protection products.
EXTENDED WARRANTY PROGRAMMES - CONSUMER
Our partnership with major retailers extends cover on all major appliances and consumer products, for personal home-use, for a period of up to 3 years beyond the normal NZ manufacturer warranty.
Typical examples of products eligible for cover include household appliances, facsimile machines, shredders, copiers, printers and computers.
If you need to make a claim our team is here to help make the process as quick and easy as possible.
The first step is to complete and send us a claim form.
Once we receive this we’ll contact you to discuss progressing your claim.
Find out more about Crown Insurance - Contact us
Freephone: 0800 246 787
Fax: 09 489 9106
Postal Address: PO Box 33 1248, Takapuna, Auckland 0622, New Zealand