I have been the person(s) named overleaf, declare that the information provided in this claim is true and properly completed to the best of my/our knowledge and belief. I/We understand that any part of this claim is in any respect fraudulent, all benefits shall be forfeited and action may be taken against you. We may share your details with other parties to assist with the handling of your claim, if you are not in agreement with us passing your details please inform us by submitting this claim form.