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Corporate Travel Claim Form

Home & Contents Claim Form

Form Generated by API

Policyholder Details

Details of Loss

Date of loss
MM slash DD slash YYYY

Ownership and Responsibility

Are you the owner of the property lost or damaged?
Was another person responsible for the damage to your property?

Police

Have the police been notified?

Insurance History

Is there other insurance on the property for which a claim is being made?
Have you made any home or contents insurance claims in the last 5 years?

Goods and Services Tax

Important: To ensure you do not incur any unnecessary GST liabilities on this claim, please complete these details.
Are you registered for GST purposes?

Electronics Funds Transfer

Important: Settlement of your claim may involve a cash settlement. Please complete the following if you are interested in an EFT Payment.

Statement of Claim

Max. file size: 512 MB.

Declaration

Important: The information and answers given above are a true and complete statement of the facts and matters relating to the happening for which this claim is made, and no information likely to affect this claim has been withheld. I authorise my Insurer to undertake on my behalf whatever actions are necessary to indemnify me within the terms of my policy including if necessary, removal of my vehicle to alternative premises to enable repairs to be carried out by a qualified Motor Body Repairer. I understand that this claim may be refused if information is untrue, inaccurate or concealed. I expressly agree that the information given by me is provided with my full knowledge and consent and further agree to hold harmless and indemnify [Value not set] in the event of any action or matter that may be taken by any party pursuant to the Privacy Act 1988 (Cth). I/We acknowledge that I/we have read and understood the paragraphs accompanying this proposal headed ?Your Privacy?
Agree
Date
MM slash DD slash YYYY

What our clients say

Confused? Don’t worry, that’s what we’re here for.
Call us on 1800 958 384

Our contact details:

Phone: +61 2 9959 2900
Fax: +61 2 9959 2999
Email: [email protected]

Our contact details:

Phone: +61 2 9959 2900
Fax: +61 2 9959 2999
Email: [email protected]

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