Make a Claim

By submission of this claim form I declare that to the best of my knowledge and belief the information in this form is true and correct and I have not withheld any relevant information. I consent to BCB using the personal information I have provided on this form for purposes of processing my claim and in accordance with BCB's Privacy Policy. Where I have completed this form as a representative of another person, I confirm that person has authorised me to disclose their personal information included on this form and for that information to be used for purposes of processing their claim and in accordance with BCB's Privacy Policy. I understand that if I choose not to provide the required details my claim may not be able to be processed.