Please provide bank details in order for your claim payment to be settled via EFT.
Note: All financial information will not be stored on our server. Only authorised personnel will have access to any financial data in the sole purpose for claim payment settlements.
I/We, the undersigned claimant(s) hereby declare that the foregoing statements and particulars of the claim are true and correct and that I/We have not withheld any information relevant to this claim.
I expressly agree that the information given by me is provided with my full knowledge and consent and further agree to
hold harmless and indemnify Maxton Insurance Brokers in the event of any action or matter that may be taken by any party pursuant to the Privacy Act 1988 (Cth).
Level 1, 22 Fullarton Road
Kent Town SA 5067
PO Box 2784
Kent Town DC SA 5071
Telephone (08) 8363 0202
Information provided on this website is general advice only and has been prepared without taking into account your objectives, financial situation or needs.