New Insurance Claim Form
Please complete below fields, providing as much information as possible.
This will assist the insurer in processing your claim.
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Requestor Details
Scheme Details
Cost Details
Attachments
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* Requestor Name
(required)
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* Requestor Contact Number
(required)
email
* Requestor Email
(required)
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* Scheme Number
(required)
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Are You GST Registered?
(required)
Yes
No
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* If yes please provide ABN Number & ITC %
(required)
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* Claim Referance No
(required)
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* Status
(required)
policy
* Policy No
(required)
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* Coverage
(required)
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* Insurer
(required)
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Insurer Phone
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* Claim Type
(required)
Select
Strome Damage (hail, strong winds, electrical power surge, lightning, flood, structural etc.)
Water Damage (concrete spalling, flood, roof hole/sagging, electrical etc.)
Glass Breakage
Impact Damage (Graffiti, vandalism etc.)
Break & Enter (in most cases you will require a police report number)
Fusion
Burst Pipes
OTHER (a complete description is required, upload an attachment if needed)
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* Incident Date
(required)
description
* Loss Details
(required)
Add an Item Claimed by clicking
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File Name
Action
description
Remarks
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I hereby declare that the information contained within this document is true and correct and I make this declaration on the basis that i have been delegated power to sign for and on behalf of the Owners Corporation.
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