Get Expert Help for Your Farm or Business Insurance Claims

Policy Details

Policy Number

Best Contact Person (if not the insured, relationship to claim)(Required)

Email

Phone(Required)

Are you registered to GST claim?

Yes

No

ABN number

Do you intend to claim any Input tax Credit (ITC) on the GST applicable to this policy?

Yes

No

Specify percentage claimed

Incident Details

Date of incident(Required)

Time of loss

:

Location of Address(Required)

Street Address Address Line 2 City State Post Code

What happened(Required)

(i.e Tree fell on my house)

Cause of loss

(i.e Storm)

Areas affected

(e.g. lounge room, ceiling) or item lost or damage

Special Requirements

Are there any immediate safety concerns or risk of further damage to the property? Pop out questions if yes- “Please provide further details”

Are there any immediate safety concerns or risk of further damage to the property?(Required)

Yes

No

Please provide details immediate safety concerns

Have you engaged a repairer?

Yes

No

Have you engaged a repairer? If so, please provide contact details.

Name

First

Phone

Address

Street Address Address Line 2 City State Post Code

Did Police attend?

Yes

No

Name of Officer

Phone

Report number

Supporting Documentation

Drop files here or

Max. file size: 256 MB.

Photos, Reports, Quotes

Declaration

Are you the policy holder or are you lodging this on behalf of someone else?(Required)

I'm the policy holder

Behalf of someone else

I/We declare that to the best of my/our knowledge and belief the information in this form is true and correct and I/we have not withheld any relevant information. I/We understand providing false information could result in this claim and potentially this insurance policy being declined/cancelled.

I/We consent to the insurance company using my personal information I/we have provided on this form for the purpose of processing my claim. I/We understand that if I/we choose not to provide required details, this is my/our choice, however, the insurance company may not be able to process my claim.

I/We consent to the insurance company disclosing my personal information to other insurers, an insurance reference service or as required by law. I/We consent to the insurance company also disclosing my personal information to and/or collecting additional information about me, from investigators or legal advisors.

Name(Required)

Date(Required)

Signature (policy holder)(Required)

Additional Claim Notes

Declaration on behalf of

If your claim is being filled out by someone other than the policy holder.