Home » Claims Lodge an Insurance Claim Lodge a claim. Please fill out the following applicable form and submit, and we will contact you regarding your claim. Liability ClaimsGeneral Property ClaimsMotor Vehicle Claims Insured Name* Company* Phone*Mobile*Email* Date MM slash DD slash YYYY Time : Hours Minutes AM PM AM/PM Exact Place of Occurrence Suburb State Postcode Name of person(s) injured or owner(s) of property lost or damaged State nature of personal injury or loss/damage sustained State exactly what happened and how it occurred Witness(es) Name(s) Address(es) Has a report of personal injury/damage been made to you by a 3rd party claimant? Yes No If so, when and by whom? Have any claims been made on you either verbally or in writing? Yes No Did you admit liability in any way? Yes No Any estimate available for damaged property? Yes No Have you any other information we should be aware of?Your Name First CAPTCHA Insured Name* Company* ABN* Phone*Mobile*ITC Percent Email* Address Street Address Suburb State Postcode Type of claim Date of loss/damage MM slash DD slash YYYY Time : Hours Minutes AM PM AM/PM Where did loss/damage occur? How did loss/damage occur? Has damage been repaired? Yes No Has the invoice been paid? Yes No Police report number Police Station Date Notified MM slash DD slash YYYY Officer name How were the premises entered? Did the Fire Brigade attend? Yes No Type of appliance Age Electrical contractor report available? Yes No Is the pool above ground? Yes No Your Name CAPTCHA Insured Name* Company* ABN* Phone*Mobile*ITC Percent Email* Date of Incident MM slash DD slash YYYY Time : Hours Minutes AM PM AM/PM Exact place of incident Suburb StateNSWQLDNTSATASVICWAPostcode Description of incidentDate of loss/damage MM slash DD slash YYYY Vehicle Make Vehicle Rego Location now Is it drivable? Yes No Drivers Name Date of Birth MM slash DD slash YYYY License Number Expiry Years Licensed Alcohol or drugs in the last 24 hours? Yes No Breathalyser or blood test taken? Yes No Police in attendance? Yes No Report number Station and officer name Other party name Address PhoneClaim form sent? Yes No Repair quotes obtained? Yes No Your Name CAPTCHA