Authority to Release Personal Information

Insurer *

Claim / File Reference Number *

First Name *

Last Name *

DOB *

Phone Number *

Email Address *

Address *

Street address *

Suburb *

City *

Postcode *

Authority Statement

I grant General and Travel Investigations Limited (‘GTI’) authorization, as per the Privacy Act 2020 (NZ)/Privacy Act 1988 (Australia), to conduct enquiries on my behalf.
It is explicitly understood that these enquiries will be strictly limited to matters directly related to my insurance claim – and that those enquiries will be conducted in an appropriate and respectful manner. This includes obtaining and exchanging relevant information with any individual, company, or government department.
The enquiries are confined to acquiring information necessary for a thorough and accurate investigation of my Claim or Policy. This may encompass, but is not limited to, obtaining copies of documents provided to insurers, assessment or investigation reports, claims histories, settlement details, and file notes.
The collection and processing of personal information will adhere to the stipulations of the Privacy Act, ensuring that the investigation remains focused solely on aspects pertinent to my insurance Claim or Policy eligibility.
I understand I can obtain further information about how GTI handles my personal information by contacting the GTI Privacy Officer at privacy@GTI.co.nz
I understand I can withdraw or change my consent to share information and/or my permission for a third party to act on my behalf at any time, by emailing Admin@GTI.co.nz
Further information on Personal Information and Your Privacy can be found further in this document.

I confirm I have read and understood this Privacy Authority Statement. I authorise any person or organisation that holds my personal information to disclose it to General & Travel Investigations Ltd (GTI) and its Agents for the purposes described in this form, in relation to the matter listed above. *

Interview Consent

If you have been requested to participate in an interview, please review and complete the form below.

An interview may be required where the insurer needs to obtain detailed information directly from you in an efficient, accurate, and fair manner so that the claim can be fully and properly assessed.
You agree to provide a formal recorded statement to a Licensed Private Investigator acting on behalf of GTI.
The interview will be conducted in an objective, honest, efficient, transparent, and fair manner at all times.
The interview will ordinarily be conducted either
by digitally recorded video interview,
in person and recorded using a digital recorder.
If there are compelling reasons why those interview formats are not suitable, alternative arrangements may be considered where appropriate.
You understand that you may be asked questions about the claim and invited to provide any information, explanations, documents, or other material you wish to have considered.
You agree to provide a truthful account during the course of the interview. Any evidence or documents you provide should be truthful and correct to the best of your knowledge and belief.
You are entitled to request a copy of your interview record. Any such request must be made in writing to the GTI Privacy Officer at privacy@GTI.co.nz
You understand that you may have an independent personal support person or legal representative present during the interview if you wish.
You agree to advise the Investigator if you have taken any medication or alcohol, or if you currently suffer from any illness, condition, or impairment that may affect your ability to participate in the interview.
A single interview sitting will not exceed 90 minutes. You will be offered a 5-minute break every 30 minutes.
If you are not comfortable proceeding in English, an interpreter can be provided to you free of charge. Please advise which language you are most comfortable using.
Further information about the investigation and interview process, and how GTI handles your personal information, is available on our website at www.gti.co.nz

I confirm that I have read and understood the information above and agree to proceed. I confirm that the information I provide during the interview will be truthful and correct to the best of my knowledge and belief. *

I am comfortable proceeding in English *

YesNo

If No, my preferred language is:

I will advise the interviewer if I have taken medication or alcohol, or have an illness, condition, or impairment that may affect my ability to participate in the interview. *

Declaration

I have read and understood the Privacy Authority and Consent Form above, and I authorise the release of my personal information to GTI and its Agents for the purposes described in this form. *

I have read and understood the interview consent information above and agree to proceed with the interview on that basis. *

Signature *

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Printed Name *

Date Signed *

Identification *

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Drivers License or Passport

Personal Information and Your Privacy

GTI are strongly committed to protecting your personal information and your privacy. GTI acknowledge that your personal or sensitive information will be collected used stored and disclosed appropriately.
To ensure that all information is protected, GTI complies with the New Zealand Privacy Act 2020 and, where applicable, the Australian Privacy Act 1988 in protecting your personal information.
Your information will be retained for only as long as required for the purpose and legal obligations.
Further information on how your personal information is handled is available on www.GTI.co.nz/Privacy
If you have any questions, comments, or requests for further information on how your personal or sensitive information is handled, please contact the GTI Privacy Officer at Privacy@GTI.co.nz
If you would prefer not to use the online form, you are welcome to print and complete it by hand and return it by post or courier or email a clear scan/photo (image or PDF). You can also “print to PDF,” complete it digitally on your device, and email it back.
We can provide a text-only version of this same form that you can complete in an email.