This document collects personal information about you so the New Zealand Firefighters Welfare Society can consider your claim.

The information is received and held by the New Zealand Firefighters Welfare Society, PO Box 30777, Lower Hutt 5040.

You may request access to, and correction of, this information according to the provisions of the Privacy Act 2020.

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

I agree that the New Zealand Fire Fighters Welfare Society may give or obtain from appropriate individuals or organisations information relevant to evaluate and administer this claim.

​I agree that an electronic version of this authorisation shall be considered as effective and valid as the original and that electronic receipts submitted are copies of the original invoices (please retain the original receipts in case we require them later).

By checking this box you agree to the privacy statement above.