OMI Verification - Coburn Corporate Intelligence

Important request for claimants in the OMI/Quilter proceedings as per email update issued on 15/8/2022.

View email & instructions here.

1. Please click the links below to view the documents

Claim Form against Quilter
Particulars of Claim against Quilter
Appendices to Particulars of Claim against Quilter:

2. Provide your response.

"*" indicates required fields

Your Full Name*

The full name of the person submitting this form.

Policyholder name*

The Full name/s of the person or company that owns this policy.

Policy Number*

Your OMI/Quilter Policy number/s (2XXXXXXX)

Confirmation*

Please confirm whether; 1. You believe the facts contained in the Claim Form and Particulars of Claim are true and; 2. You authorise a Callin Wild Advocate to sign statements on your behalf confirming the facts contained in the Claim form and Particulars of Claim are true.

Authority Confirmed

Authority Withdrawn

Waiver*

Have you been approached by Quilter demanding you waive your claim to enable you to surrender your bonds? In the event you believe the facts are true but wish to withdraw for other reasons please tick and provide reasons. PLEASE NOTE: IF YOU WISH TO WITHDRAW AS EXPLAINED AT SIGN UP, THE COURT HAS THE POWER TO AWARD COSTS AGAINST YOU.

I have or intend to sign the waiver, and I wish to withdraw.

I have or intend to sign the waiver, but I do not wish to withdraw (please provide reasons below).

I have not received a waiver

Other (please provide explanation)

Waiver explanation*

Waiver upload

Please attach a copy of the waiver, signed or unsigned.

Max. file size: 512 MB.