Declaration Of Loss Or Damage Claim

Claim form

Begin your claim

Complete the form below to report property loss or damage and provide the details needed to start the claims process.

Policy Details

Due Date
DD slash MM slash YYYY

Claimant / Owner Details

Details of Loss or Damage

Date of Loss / Damage
DD slash MM slash YYYY

Police Report

Was the incident reported to police?
Date Reported
DD slash MM slash YYYY

Third Parties

Are there any third parties involved in this claim?

Witnesses

Were there any witnesses to the incident?
Is the Owners Corporation registered for, or intending to be registered for GST?
If so, is the Owners Corporation claiming or entitled to claim input tax credits?

Settlement Details

Supporting Documents

Please indicate which supporting documents you are attaching with this claim:

Supporting Documents

Declaration

I/We declare that:

  • The information provided in this claim form is true and correct to the best of my/our knowledge and belief.
  • I/We have not wilfully misrepresented any facts or circumstances relevant to this claim.
  • I/We understand that providing false or misleading information may result in the claim being declined and I/we may be prosecuted.
  • I/We consent to the insurer obtaining information from relevant parties as necessary to process this claim.
  • I/We have read the Product Disclosure Statement and the particulars contained herein to be true in every particular, and that I/We have complete authority to sign for or on behalf of the Insured.
Declaration Agreement(Required)
Date(Required)
DD slash MM slash YYYY

Signature

Type your full name as your signature.
This field is for validation purposes and should be left unchanged.

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