I declare that the answers given on this claim form and the circumstances surrounding this claim are true and correct.
I declare I have not withheld any information relevant to the claim of which AllInsure should be made aware.
I consent to AllInsure using the personal information (including sensitive information) I have provided on
this form for the purposes of processing my claim. I consent to the disclosure of personal information (including
sensitive information) to third parties in order to process my claim.
I understand that if this consent is not given AllInsure will not be able to process this insurance claim.
I understand that by investigating my claim or by accepting proof of my claim, AllInsure has made no acceptance
of liability, nor waived any of its rights in defence of any claim arising under the policy.
I authorise any person or entity, including but not limited to the parties referred to above, to provide to AllInsure such
personal information as AllInsure in its absolute discretion considers relevant for its assessment of my claim or my entitlement