Home » Claims Claims 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 Time : HH MM AM PM Exact Place of OccurrenceSuburbStatePostcodeName of person(s) injured or owner(s) of property lost or damagedState nature of personal injury or loss/damage sustainedState exactly what happened and how it occurredWitness(es) Name(s)Address(es)Has a report of personal injury/damage been made to you by a 3rd party claimant?YesNoIf so, when and by whom?Have any claims been made on you either verbally or in writing?YesNoDid you admit liability in any way?YesNoAny estimate available for damaged property?YesNoHave you any other information we should be aware of?Your Name First This iframe contains the logic required to handle Ajax powered Gravity Forms. Insured Name*Company*ABN*Phone*Mobile*ITC PercentEmail* Address Street Address Suburb State Postcode Type of claimDate of loss/damage Time : HH MM AM PM Where did loss/damage occur?How did loss/damage occur?Has damage been repaired?YesNoHas the invoice been paid?YesNoPolice report numberPolice StationDate Notified Officer nameHow were the premises entered?Did the Fire Brigade attend?YesNoType of applianceAgeElectrical contractor report available?YesNoIs the pool above ground?YesNoYour Name This iframe contains the logic required to handle Ajax powered Gravity Forms. Insured Name*Company*ABN*Phone*Mobile*ITC PercentEmail* Date of Incident Time : HH MM AM PM Exact place of incidentSuburbStateNSWQLDNTSATASVICWAPostcodeDescription of incidentDate of loss/damage Vehicle MakeVehicle RegoLocation nowIs it drivable?YesNoDrivers NameDate of Birth License NumberExpiryYears LicensedAlcohol or drugs in the last 24 hours?YesNoBreathalyser or blood test taken?YesNoPolice in attendance?YesNoReport numberStation and officer nameOther party nameAddressPhoneClaim form sent?YesNoRepair quotes obtained?YesNoYour Name This iframe contains the logic required to handle Ajax powered Gravity Forms.
