Motorcycle Theft Claim Form

1. Insured Details

Name of Insured

Authorised Contact

2. Goods and Services Tax

What is your entitlement to an input Tax Credit in respect of

3. Motorcycle Details

4. Type of Claim

5. Claim Details

8. Witness Details

9. Other Damage

10. Disclosure Questions

Privacy

We are committed to protecting your privacy.

We collect the personal information we need to assess insurance applications, provide quotations, issue insurance policies and assess claims made under them. We may not be able to do these things if you don’t provide the information we need.
We provide your personal information to the insurer that underwrites your insurance and our related companies. We provide your name and policy number to any intermediary that arranged your policy or referred you to us. We may also provide relevant personal information to our trusted suppliers including financiers, loss adjusters, assessors, repairers, professional advisers, document storage centres, mailing houses and IT software / service providers, some of whom may be based or controlled in the United States.

If you make a claim, we may also need to provide relevant personal information to authorities (such as the police, licensing and registration bodies and the Australian Financial Security Authority) and to other insurers in the event of recovery or litigated action.

We may use your contact details to send you information and marketing communications that we believe will be of interest to you. You can opt out from receiving these at any time.

Our Privacy Policy contains more information about how we manage your information including how you can access it, ask us to correct it or make a privacy related complaint. This is available free of charge on our website and on request by telephone: (02) 8920 1157 or email: contact@nminsurance.com.au.

If you provide us with personal information about another person, you must have their consent to do so and give them the information in this statement.

Claims Procedure

What you need to do:

• Take every reasonable precaution to prevent further loss, damage, cost or liability.
• Notify the police as soon as possible if the incident involves injury, theft, attempted theft, malicious acts, or impact by a vehicle.
• Notify us as soon as possible about the claim.
• Assist us to manage the claim. This may include us inspecting your motorcycle, interviewing you, or you providing written statements to us under oath.
• Provide us with all reasonable proof that we require in respect of lost or damaged items claimable under this policy.
• Keep items that have been damaged and make them available for inspection or assessment of repair costs.
• Allow us to take possession of damaged property that is the subject of a claim.

You must not:

• Admit guilt, fault, or liability (except to the Police)
• Approve any repairs or arrange replacements (other than emergency repairs reasonably necessary to protect your motorcycle against further loss or damage)
• Dispose of any damaged property.

Declaration

I/we have read and understood the above Privacy Collection Statement. I/we acknowledge NM Insurance Pty Ltd (ABN 34 100 6330 38 AFSL 227186) may give to, or obtain from, other insurers and/or Insurance/Financial Bureau, state Licensing, Parts or Service Providers, personal information in relation to this claim or my insurance in general. I/we hereby declare that the foregoing particulars to be true and correct and I/we undertake to render every assistance in my/our power in dealing with this matter.