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Bike Insurance

Theft Claim Form

The issue or acceptance of this form is not to be construed as an admission of liability on the part of the company.

Please provide complete details to the questions asked on this form.
YOUR DETAILS

INCIDENT DETAILS
POLICE REPORT
ADDITIONAL INFORMATION






Page 2:
PREVIOUS CLAIMS

LOCAL BICYCLE SHOP
The details of the bike shop that you normally support:
OTHER INSURANCE

If yes, please provide details:
STOLEN ITEMS
List your stolen items:
To avoid delays in processing your claim, please attach all original purchase invoices where available.:
DECLARATION
•  I hereby certify that the information given in this form is truthful, accurate and complete. No information likely to affect this claim has been withheld. I understand that this claim may be refused if information is untrue, inaccurate or concealed.
•  I authorise Aon Risk Solutions to give to, or obtain from, other insurers or any insurance reference bureau, any information to this claim or any other claim made by me or any insurance held by me.:
PRIVACY
  1. Aon is committed to protecting your personal information in accordance with the Australian Privacy Principles under the Privacy Act 1988 (Cth). We collect, use and disclose personal information to offer, promote, provide, manage and administer the many financial services and products we and our group of companies are involved in as set out in the Aon Privacy Notice.

  2. If you are disclosing personal or sensitive information about any other person to Aon, you confirm that you have obtained the consent of that person to disclose to Aon their personal or sensitive information and you have made them aware that Aon will or may disclose their information to third parties that are reasonably necessary to assist in the provision of the relevant services or products. If you have not obtained consent from this other person to disclose their personal or sensitive information to Aon, you will inform us before providing the relevant information to us.
By submitting this form, you acknowledge that you have read the Aon Privacy Notice and agree that we can handle any personal information you have provided to us in the manner set out above.:

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