Personal Accident Insurance Accident Claim Form

The Customer agrees that under the RTGS/ NEFT facility, there may be a risk of non-payment in the Account of Customer on the day of the credit of Payments due to change in the

Permanent Total Disablement / Permanent Partial Disablement / Temporary Total Disablement: Claim Form duly filled & signed Claim Intimation.

I consent to CGU Insurance using my personal information I have provided on this form for the purpose of processing my claim. I understand that if I choose not to provide the

b) I/We consent to CGU Insurance using my personal information I have provided on this form for the purpose of processing my claim. I understand that if I choose not to provide

I have read and I understand my statutory rights under the Access to Medical Reports Act 1988/Access to Personal Files and Medical Reports (Northern Ireland) Order 1991/Access to

I confirm that the above named claimant nominated on this claim form is a paid registered member of the Athletics Australia Personal Accident Insurance Program.. Where the

In connection with my claim, I hereby consent to Stonebridge International Insurance Ltd or its agent, being provided with medical information from any Doctor who has attended

Personal Accident Insurance claim Complete and send to: HCF Life Insurance Company Pty Ltd GPO Box 4445, Sydney, NSW 2001 Please note that we also require the attached