Extra care and support request

The protection of your information is important to us, and we are committed to protecting and respecting your information in line with our responsibilities under the Privacy Act. We will only capture information that is required for us to be able to provide an appropriate outcome to suit your circumstances. We will not use your information for any other purposes. We will never share your information with anyone outside of IAG without your consent, unless:

• We believe there is any concern for your safety, or the safety of our employees
• We are concerned there are children at risk of, or currently being harmed
• There is an imminent threat of physical harm, or loss of life
• If we are required or permitted to do so by law

Your information is collected for insurance related purposes, including understanding your personal situation if you require extra care and support. If you do not provide us with accurate and complete information, we may be unable to assess your situation. You can access and correct your information by emailing us at privacy@iag.co.nz or by writing to us at:

The Privacy Officer
IAG New Zealand Limited
Private Bag 92130
Victoria Street West
Auckland 1142

Your information is collected and held by IAG, 1 Fanshawe Street, Auckland 1010.

• Please confirm your consent for the information you provide in this form, or in any follow-up discussion, to be collected, used, and stored by IAG*
• If you are completing this form on behalf of another person, please confirm you have their consent to disclose their information to IAG and for IAG to collect, use and store that information

• Our Customer Care Team can provide support for a range of circumstances. Please complete the form below to let us know how we can help. You can select multiple options:*

  I am experiencing financial challenges related to COVID-19

  I have unexpected financial challenges e.g., sudden loss of income, capacity to earn or affordability concerns (Not related to COVID-19)

  I am impacted by Family and Domestic Violence and need support

  I need support because of a physical disability, impairment, or trauma

  I need support because of intellectual or learning disability or acquired brain injury

  I need support because of my mental health

  I need support because of a physical illness or health condition

  I need support because I have experienced a bereavement

  I need support relating to my age or life stage (e.g., minor, pregnancy, retirement, elderly, relationship separation)

  I need support because I am not confident or have difficulty doing things online

  I need support relating to my sexual orientation or gender identity

  I need support with one or more of the above areas, and I have difficulty communicating in english

  Other

• Please let us know a little more about what you are needing help with, so we know how to best support you:

• We will aim to get back to you within five working days. However, if you need a more immediate response or need general support then please contact your insurer or broker.

• First name*

• Last name*

• Phone number*

• Email address*

• Preferred method of contact*

  Phone

  Email

• Preferred time of contact (we will do our best to accommodate your preference)*

• If you know your policy or claim number, please enter it

  You can enter multiple if required

• Which brand are you insured with?*

  AMI	State
  NZI	Swann
  Lantern	Lumley
  NAC	BNZ
  ASB	Westpac
  Co Operative Bank	Don't Know

• What kind of insurance policy do you have with us?

  Car

  Contents

  House

  Business

  Other

• Do you have a premium payment due in the next 48 hours?*

  Yes

  No

• Is this request related to a claim?*

  Yes

  No