1300 732 499

About Us
- How We Compare
Insurance Services
Claims
Contact Us
Request a Quote

About Us
- How We Compare
Insurance Services
Claims
Contact Us
Request a Quote

Home » Claims

Claims

Lodge a claim. Please fill out the following applicable form and submit, and we will contact you regarding your claim.

Liability Claims

General Property Claims

Motor Vehicle Claims

Insured Name*
Company*
Phone*
Mobile*
Email*
Date
Time

: HH

MM
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

Insured Name*
Company*
ABN*
Phone*
Mobile*
ITC Percent
Email*
Address
Street Address Suburb State Postcode
Type of claim
Date of loss/damage
Time

: HH

MM
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
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

Navigation

About Us
Insurance Services
How We Compare
Claims
Privacy Statement
Contact Us

Insurance Services

Earthmovers
Quarries
Crane Operators
Trucks
Civil Contractors

Copyright 2019 © Dirtpak.com.au. All Rights Reserved | Web Design Brisbane by Web Ignite