Amend All Risk - OneNet Health and Insure

Name*

First Last

Personal Information*

ID Number	Policy Number

Contact Information*

Telephone	Email Address

Are you Adding or Deleting?*

Items to Add

Item Make & Model	Serial Number	Insured Value

Items to Remove

Item Make & Model	Serial Number	Insured Value

File Upload

Drop files here or

Proof of Purchase, Valuation Certificate etc

Date to do this change?*

Declaration*

In the event of a loss I understand the onus will be upon me to provide proof of ownership by means of a valuation certificate, receipt or invoice.