Make a Claim

Select the type of insurance you are claiming for

Claim Form - Machinery Breakdown

Name of Insured(Required)

Phone

Email

Date of Loss(Required)

Description of Incident(Required)

Address Where Incident Occurred(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you consider any other party responsible for the loss?

Yes

No

Are you the sole owner of the property lost or damaged?

Yes

No

Is the motor under a manufacturers warranty?

Yes

No

Details of Damaged Items(Required)

Item Damaged

Purchase Date

Replacement Value

Name of Repairer

Repairer's Phone Number

Repairer's Email

Additional Information

Name(Required)

First Last

Date(Required)

File

Drop files here or

Accepted file types: png, jpg, jpeg, pdf, doc, docx, gif, heic, Max. file size: 16 MB.

Claim Form - Motor Vehicle Windscreens Only

Name of Insured(Required)

Date of Loss(Required)

Phone

Email

Address where incident occurred(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Vehicle Details - Year, Make & Model(Required)

Registration No.(Required)

Serial/Engine No

Description of Incident(Required)

Where is the vehicle currently located?(Required)

Has the windscreen been repairer/replaced?(Required)

Yes

No

If YES, has the repair account been paid?

Yes

No

If Yes, please attach a copy of the tax invoice

If NO, have you found a repairer and has the repair been quoted?

If YES, please attach quote

If NO, would you like the insurer to arrange a repairer

Additional Information

Name(Required)

First Last

Date(Required)

File

Drop files here or

Accepted file types: png, jpg, jpeg, pdf, doc, docx, gif, heic, Max. file size: 16 MB.

Claim Form - Property Damage

Name of Insured(Required)

Date of Loss(Required)

Phone

Email

Address Where Damage Occurred(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Description of Incident(Required)

What emergency repairs have been made to minimise further loss or damage?

Description of Property Lost or Damaged(Required)

Description

Date of Purchase

Replacement Value

Witness Details

First Last

Phone

Additional Information

Name

First Last

Date(Required)

File

Drop files here or

Accepted file types: png, jpg, jpeg, pdf, doc, docx, gif, heic, Max. file size: 16 MB.

Claim Form - Liability

Name of Insured(Required)

Phone

Email

Date(Required)

Address Where Incident Occurred

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Describe what happened(Required)

Were there any witnesses?

Yes

No

If Yes, please provide details below

Witness Name

First Last

Phone or Email

Did the police attend the accident/incident?

Yes

No

If Yes, please provide details below

Officers Name

First Last

Name of Station

Property Details - describe the property that was damaged

Item

Replacement Value

Name of Inured Person

First Last

Phone

Email

Address of Injured Person

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

What were the injuries?

What medical assistance is necessary?

Doctor

Ambulance

Hosptial

Additional Information

Name(Required)

First Last

Date(Required)

File

Drop files here or

Accepted file types: png, jpg, jpeg, pdf, doc, docx, gif, heic, Max. file size: 16 MB.

Claim Form - Theft

Name of Insured(Required)

Date of Loss(Required)

Phone

Email

Address Where Damage Occurred(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Description of Incident(Required)

How/where was entry gained into the premises?(Required)

What emergency repairs have been made to minimise further loss or damage?

Description of Property Lost or Damaged(Required)

Description

Date of Purchase

Replacement Value

Was the incident reported to the police?(Required)

Police Station

Officers Name

First Last

Police Report No.

Witness Details

First Last

Phone

Additional Information

Name(Required)

First Last

Date(Required)

File

Drop files here or

Accepted file types: png, jpg, jpeg, pdf, doc, docx, gif, heic, Max. file size: 16 MB.

Claim Form - Travel

Name of Insured(Required)

Phone

Email

Departure Date(Required)

Return Date(Required)

Departure City

Destination City

Departure Country

Destination Country

Date of Incident(Required)

Incident City

Incident Country

Description of Incident(Required)

Was the Emergency Assistance Company contacted?

If an illness, has the claimant suffered this complaint before?

Details of Medical Expenses Incurred

Date of Expense

Description

Amount

Description of Property Lost or Damaged(Required)

Description

Replacement Value

Was the incident reported to the police/authorities?

Yes

No

If Yes, provide details

Have you incurred additional travel expenses?

Yes

No

Additional Expenses

Date of Expense

Description

Amount

Have you been involved in a motor vehicle incident?

Yes

No

Name of Hire Car Company

Driver's Name

First Last

Vehicle Excess

Repair Costs

Amount Being Claimed

Additional Information

Name(Required)

First Last

Date(Required)

File

Drop files here or

Accepted file types: png, jpg, jpeg, pdf, doc, docx, gif, heic, Max. file size: 16 MB.

Claim Form - Home

Name of Insured(Required)

Phone

Email

Date of Loss(Required)

Where did the loss or damage occur?(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Description of how the loss or damage occurred.(Required)

Was another person responsible for the damage?

Yes

No

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

If damage is the result of fire, did the fire brigade attend?

Yes

No

If damage/loss is the result of burglary, were the police notified?

Yes

No

Police Report No.

Please attach a copy of the police report

Items Damaged, Lost or Stolen(Required)

Description

Purchase Date

Replacement Value

Please provided copies of tax invoices or repair quotes.

Additional Information

Please advise if emergency repairs have already been completed

Name(Required)

First Last

Date(Required)

File

Drop files here or

Accepted file types: png, jpg, jpeg, pdf, doc, docx, gif, heic, Max. file size: 16 MB.

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submit your claim form here

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Make a claim

Claim Form - Strata

Claim Form - Machinery Breakdown

Claim Form - Motor Vehicle

Claim Form - Motor Vehicle Windscreens Only

Claim Form - Property Damage

Claim Form - Liability

Claim Form - Personal Accident and Illness

Claim Form - Theft

Claim Form - Transit

Claim Form - Travel

Claim Form - Boat

Claim Form - Caravan

Claim Form - Landlord

Property Damage or Theft

Loss of Rent

Tenant Default

Claim Form - Home

Stalk us

Trading Hours

Alstonville, NSW

Bundaberg, QLD

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