{"id":27465,"date":"2024-02-01T08:51:25","date_gmt":"2024-02-01T08:51:25","guid":{"rendered":"https:\/\/www.battleface.com\/?page_id=27465"},"modified":"2024-02-01T09:06:48","modified_gmt":"2024-02-01T09:06:48","slug":"file-a-claim","status":"publish","type":"page","link":"https:\/\/www.battleface.com\/en-au\/file-a-claim\/","title":{"rendered":"File a claim"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"27465\" class=\"elementor elementor-27465\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-41d8a90 e-flex e-con-boxed e-con e-parent\" data-id=\"41d8a90\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-db439b3 elementor-widget elementor-widget-spacer\" data-id=\"db439b3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-d95068c e-flex e-con-boxed e-con e-parent\" data-id=\"d95068c\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-75e31cc elementor-widget elementor-widget-heading\" data-id=\"75e31cc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">File a claim<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-9c16d75 e-flex e-con-boxed e-con e-parent\" data-id=\"9c16d75\" 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d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_55' style='display:none'><div id='gf_55' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_55'  action='\/en-au\/wp-json\/wp\/v2\/pages\/27465#gf_55' data-formid='55' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LfVOvcsAAAAAP4PgmPvNA6OWkBDC2ZxKb3gcE7y' data-tabindex='0'><input id=\"input_b162997e50f5c4fb9ca10fe37741e153\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_b162997e50f5c4fb9ca10fe37741e153\" value=\"\"\/><\/div><div id='gf_page_steps_55' class='gf_page_steps'><div id='gf_step_55_1' class='gf_step gf_step_active gf_step_first'><span class='gf_step_number'>1<\/span><span class='gf_step_label'>Personal Information<\/span><\/div><div id='gf_step_55_2' class='gf_step gf_step_next gf_step_pending'><span class='gf_step_number'>2<\/span><span class='gf_step_label'>Claim Information<\/span><\/div><div id='gf_step_55_3' class='gf_step gf_step_last gf_step_pending'><span class='gf_step_number'>3<\/span><span class='gf_step_label'>Consent<\/span><\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_55_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><ul id='gform_fields_55' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_55_113\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_55_113'><span class='gform-field-label__text'>Facebook<\/span><\/label><div class='ginput_container'><input name='input_113' id='input_55_113' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_55_113'>This field is for validation purposes and should be left unchanged.<\/div><\/li><li id=\"field_55_2\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_55_2'>\n                            \n                            <span id='input_55_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.3' id='input_55_2_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_55_2_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_55_2_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.6' id='input_55_2_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_55_2_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_55_112\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_55_112'><span class='gform-field-label__text'>Policy Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_112' id='input_55_112' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_55_3\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_55_3'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_3' id='input_55_3' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_55_3\" \/>\n                        <\/div><div class='gfield_description' id='gfield_description_55_3'>The email address used to purchase the policy<\/div><\/li><li id=\"field_55_4\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_55_4'><span class='gform-field-label__text'>Contact number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_55_4' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_55_5\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_55_5' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_55_5_1_container' >\n                                        <input type='text' name='input_5.1' id='input_55_5_1' value=''    aria-required='true'    \/>\n                                        <label for='input_55_5_1' id='input_55_5_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_55_5_3_container' >\n                                    <input type='text' name='input_5.3' id='input_55_5_3' value=''    aria-required='true'    \/>\n                                    <label for='input_55_5_3' id='input_55_5_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_55_5_4_container' >\n                                        <input type='text' name='input_5.4' id='input_55_5_4' value=''      aria-required='true'    \/>\n                                        <label for='input_55_5_4' id='input_55_5_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_55_5_5_container' >\n                                    <input type='text' name='input_5.5' id='input_55_5_5' value=''    aria-required='true'    \/>\n                                    <label for='input_55_5_5' id='input_55_5_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_5.6' id='input_55_5_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_55_6\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Are you making this claim on behalf of someone else?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_55_6'>\n\t\t\t<li class='gchoice gchoice_55_6_0'>\n\t\t\t\t<input name='input_6' type='radio' value='Yes'  id='choice_55_6_0'    \/>\n\t\t\t\t<label for='choice_55_6_0' id='label_55_6_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_55_6_1'>\n\t\t\t\t<input name='input_6' type='radio' value='No'  id='choice_55_6_1'    \/>\n\t\t\t\t<label for='choice_55_6_1' id='label_55_6_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_55_7\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Claimant name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_55_7'>\n                            \n                            <span id='input_55_7_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_7.3' id='input_55_7_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_55_7_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_55_7_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_7.6' id='input_55_7_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_55_7_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <button type='button' id='gform_next_button_55_62' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_55_2' class='gform_page' data-js='page-field-id-62' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_55_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_55_105\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_55_105'><span class='gform-field-label__text'>What happened?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_105' id='input_55_105' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_55_106\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_55_106'><span class='gform-field-label__text'>When did it happen?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/yyyy'\n\t\t\t\t\tid='input_55_106'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_106'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_55_106' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_55_106' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_55_106' aria-label='When did it happen?: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/li><li id=\"field_55_108\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_55_108'><span class='gform-field-label__text'>Where did it happen?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_108' id='input_55_108' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_55_110\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Total Amount<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_55_110'>\n                            \n                            <span id='input_55_110_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_110.3' id='input_55_110_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_55_110_3' class='gform-field-label gform-field-label--type-sub '>Currency<\/label>\n                                                <\/span>\n                            \n                            <span id='input_55_110_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_110.6' id='input_55_110_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_55_110_6' class='gform-field-label gform-field-label--type-sub '>Amount<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_55_20\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_55_20'><span class='gform-field-label__text'>Attach supporting documents:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_55_20' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_55_20&quot;,&quot;container&quot;:&quot;gform_multifile_upload_55_20&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_55_20&quot;,&quot;filelist&quot;:&quot;gform_preview_55_20&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/www.battleface.com\\\/?gf_page=ede252ac3685da6&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/www.battleface.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/www.battleface.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;16777216b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:55,&quot;field_id&quot;:20,&quot;_gform_file_upload_nonce_55_20&quot;:&quot;682a9695eb&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;10&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_55_20&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_55_20' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_55_20' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_55_20\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_55_20'>Max. file size: 16 MB, Max. files: 10.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_55_20'><\/ul> <div id='gform_preview_55_20' class='ginput_preview_list'><\/div><\/div><\/li><li id=\"field_55_111\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_55_111'><span class='gform-field-label__text'>Any additional Information<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_111' id='input_55_111' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_55_61' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_55_61' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_55_3' class='gform_page' data-js='page-field-id-61' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_55_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_55_56\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>first tick box<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input name='input_56.1' id='input_55_56_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_55_56_1' ><span class='gform-field-label__text'>I \/ We confirm that the information provided in this form and in any accompanying supporting documentation is true, accurate and complete to the best of all claimants\u2019 knowledge. In the event of false, inaccurate or incomplete information being provided, battleface reserves the right to cancel or void your plan and\/or reject your claim in full or in part.<\/span><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/label><input type='hidden' name='input_56.2' value='I \/ We confirm that the information provided in this form and in any accompanying supporting documentation is true, accurate and complete to the best of all claimants\u2019 knowledge. In the event of false, inaccurate or incomplete information being provided, battleface reserves the right to cancel or void your plan and\/or reject your claim in full or in part.' class='gform_hidden' \/><input type='hidden' name='input_56.3' value='39' class='gform_hidden' \/><\/div><\/li><li id=\"field_55_79\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>first tick box<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input name='input_79.1' id='input_55_79_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_55_79_1' ><span class='gform-field-label__text'>I \/ We give authority to battleface (as agent of the underwriter) and their appointed representatives to approach any third-party who holds information relating to the incident giving rise to this claim, including, but not limited to medical practitioners and hospitals\/clinics where the claim relates to a medical condition or injury. Such authority will permit the third-party to release relevant information to battleface to assist in the investigation and resolution of this claim.<\/span><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/label><input type='hidden' name='input_79.2' value='I \/ We give authority to battleface (as agent of the underwriter) and their appointed representatives to approach any third-party who holds information relating to the incident giving rise to this claim, including, but not limited to medical practitioners and hospitals\/clinics where the claim relates to a medical condition or injury. Such authority will permit the third-party to release relevant information to battleface to assist in the investigation and resolution of this claim.' class='gform_hidden' \/><input type='hidden' name='input_79.3' value='39' class='gform_hidden' \/><\/div><\/li><li id=\"field_55_80\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>first tick box<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input name='input_80.1' id='input_55_80_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_55_80_1' ><span class='gform-field-label__text'>I \/ We hereby grant battleface and\/or the underwriter in full, any rights of recovery or subrogation in respect of any payments made on behalf of all claimants in accordance with applicable laws and the provisions of the plan.<\/span><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/label><input type='hidden' name='input_80.2' value='I \/ We hereby grant battleface and\/or the underwriter in full, any rights of recovery or subrogation in respect of any payments made on behalf of all claimants in accordance with applicable laws and the provisions of the plan.' class='gform_hidden' \/><input type='hidden' name='input_80.3' value='39' class='gform_hidden' \/><\/div><\/li><li id=\"field_55_81\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>first tick box<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input name='input_81.1' id='input_55_81_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_55_81_1' ><span class='gform-field-label__text'>I \/ We further agree to fully co-operate with any such recovery efforts from any liable third-party and to immediately notify battleface if any lost or stolen property mentioned in this claim form is subsequently recovered.<\/span><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/label><input type='hidden' name='input_81.2' value='I \/ We further agree to fully co-operate with any such recovery efforts from any liable third-party and to immediately notify battleface if any lost or stolen property mentioned in this claim form is subsequently recovered.' class='gform_hidden' \/><input type='hidden' name='input_81.3' value='39' class='gform_hidden' \/><\/div><\/li><li id=\"field_55_58\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><strong>IMPORTANT<strong>\nPlease note that if you do not authorise the agent\/third-party to deal with the claim, we will not be able to discuss any details of the claim in accordance with the Australian Privacy Principles and Privacy Act 1998 (Cth).\n\n<br><br>\nFor full details of our Privacy Policy <a target=\"_blank\" href=\"https:\/\/wpstaging.battleface.com\/en-au\/privacy-policy\/\">click here<\/a> \n\n<br><br><p>\nInsurance is administered by battleface Insurance Services Pty Ltd (ABN 28 650 606 045, AFSL 536280) and is underwritten by Pacific International Insurance Pty Ltd (ABN 83 169 311 193, \u201cThe Insurer\u201d). Any advice provided is general advice only.\n<\/p>\n<br>\n<p>\nThe Insurer subscribes to the General Insurance Code of Practice, developed by the Insurance Council of Australia, and enforced by the Code Governance Committee. The Code reflects the general insurance industry\u2019s ongoing commitment to positive outcomes for consumers and its determination to provide best practice in conduct and customer service. 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gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_55_84'><span class='gform-field-label__text'>Declaration Date<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_84' id='input_55_84' type='text' value='' class='medium'    placeholder='today&#039;s date in dd\/mm\/yyyy format' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><\/ul><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><button type='submit' id='gform_previous_button_55' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='submit' id='gform_submit_button_55' class='gform_button button' 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