By completing this form, you are authorising the management of all premium/debt collection and claims relating to the following employer to Allianz Australia Workers' Compensation (Victoria) Limited ACN 059 835 791. If you are transferring more than one business, please complete a separate form for each.
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If you need help completing this form, or would like further information about transferring your policy, call us on (03) 9234 3285 or 1800 240 335 (Victoria only).
Privacy Notice: The information requested on this form is being collected by Allianz Australia Workers’ Compensation (Victoria) Limited so that we can assess your request and for the management of the premium or debt collection and claims relating to the identified employer. We collect your personal information directly from you where reasonably practicable or if not, from other sources who have your permission to provide the required information on your behalf, such as a member of staff. Providing this information is voluntary, however, if you don’t provide this information, we may not be able to approve your request to transfer the management of all premium or debt collection and claims to Allianz. Where you provide us with information about another person or entity for the above purposes, you must tell us if you don’t have their consent to do this by calling us on (03) 9234 3285 (Monday to Friday, 9 AM to 5 PM AEST) or by sending us an email. Our Privacy Policy contains details about how you can request access to your personal information, make a complaint about a breach of privacy principles contained in the Privacy Act 1988 (Cth) and how we deal with complaints.
Allianz Australia Workers’ Compensation (Victoria) Limited ACN 059 853 791
GPO Box 80, Melbourne VIC 3001. Telephone (03) 9234 3285 Email: contactvicbdm@allianz.com.au
Any advice here does not take into account your individual objectives, financial situation or needs. Terms, conditions, limits, and exclusions apply. Before making a decision about this insurance, consider the relevant Product Disclosure Statement (PDS)/Policy Wording and Supplementary PDS (if applicable). Where applicable, the PDS/Policy Wording, Supplementary PDS and Target Market Determination (TMD) for this insurance are available on this website. We do not provide any form of advice if you call us to enquire about or purchase a product.
Allianz Australia Insurance Limited ABN 15 000 122 850 AFS Licence No. 234708 is the insurer of any general insurance products offered, and Allianz Australia Life Insurance Limited ABN 27 076 033 782 AFS Licence No. 296559 is the insurer of any life insurance products offered. Each entity is responsible for any statements and representations made about its products, on this website.