Residential Claim Form

Exclusive to members of New Zealand Certified Builders Association (NZCB). Please ensure this form is completed in full.

Owner Details

Name(Required)

Guarantee Number(Required)

Email(Required)

Contact Phone(Required)

Address(Required)

Street Address City State / Province / Region

Description of Defects

When did you noticed the defects?

Date(Required)

Time

When did you notify the builder?

Date(Required)

Time

What are the defects?(Required)

Please provide photos(Required)

Drop files here or

Max. file size: 10 MB, Max. files: 5.

Has the builder responded?(Required)

Yes

If you answered yes, please provide copies of any written correspondence.

Please provide copies of any written correspondence(Required)

Drop files here or

Max. file size: 10 MB, Max. files: 5.

What remedial repairs have been undertaken, if any?

Have you made a claim with your Insurer for this matter?(Required)

Yes

If you answered yes, what was the outcome? Please provide copies of any correspondence.

Please provide copies of any written correspondence(Required)

Drop files here or

Max. file size: 10 MB, Max. files: 5.

Declaration

I declare that to the best of my knowledge the details given in this claim form are true.

I undertake to render all possible assistance in connection with this claim.

I agree that Halo Guarantees Limited and the insurance company (and/or their agent) with whom I am insured may give to or obtain information relevant to this claim from appropriate individuals or organisations.

Note: Failure to provide correct and complete information could result in your claim not being accepted by Halo Guarantees Limited.

Signature

Owner(s) Signature(Required)