Transcription of Doctor’s Declaration P 122 Ss a
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Doctor’s Declaration P 122 Ss a
Latitude Insurance PO Box 108022 Symonds St, Auckland Phone: 0800 220 999 Fax: 0800 282 646 (Rev 07/19)We are a member of the Insurance Council of NZ and adhere to the Fair Insurance Code, which provides you with assurance that we have high standards of service for our Life Insurance Company Ltd. and Hallmark General Insurance Company Ltd. (incorporated in Australia and operating in New Zealand).Page 1 Doctor s DeclarationHow to help us process your claimChecklist Before submitting your claim form, make sure you can tick all the boxes below: Illness or injury claims documents required Section A: Statement of claimant (you) all questions answered. Section B: Doctor s Declaration completed, signed, dated and stamped by your usual treating doctor. Privacy consent and Declaration read, signed and dated by you. This is on the last page of this claim form.
allmar ife Insurance Company td. and allmar General Insurance Company td. (incorporated in Australia and operating in New ealand).-21 (Rev 01)
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