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).
I/We acknowledge that I/we have read and understood our Privacy Policy (opens in new tab).
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.