Address
3. phone number.
4. signature and stamp of the signature of the Policyholder/Insured.
5. date of issue.
6. name of the Policyholder/Insured (optional)
7. signature of the Policyholder/Insured (optional)
8. signature of the Policyholder/Insured (if same as above)
Signature must be in the person's own handwriting, be legible and not to be altered. In the event of a conflict, the signature of the policyholder is prima facie evidence of the facts stated in this page and form of this claim.
1. claim form (optional)
2.
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Law safe claim form Very Liability Insurance Limited Private Bag 92055 Auckland New Zealand In accordance with the conditions of the policy under no circumstances should liability be admitted or any
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