PROPERTY & THEFT CLAIM FORM
Insured name
*
First Name
Last Name
Insured address
*
Street Address
Street Address Line 2
City
State
Postcode
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
I would you like to direct this request to a particular OVIB broker
Broker's name
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INCIDENT DETAILS
Date of loss / damage
*
-
Day
-
Month
Year
Approximate time of loss / damage
*
Minutes
AM
PM
AM/PM Option
Address where loss / damage occurred
*
What happened?
*
File Upload
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Please include any photos of damages, recent valuations or receipts etc
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Was the loss / damage to your property a result of theft or vandalism?
*
Yes
No
THEFT / VANDALISM CLAIMS
You must report any loss, theft or vandalism of property to the policy
When was the premises last occupied?
*
-
Month
-
Day
Year
Was the premises securely locked?
*
Yes
No
How was entry gained?
*
Police officer details
*
Officer name
Station
Police report number
*
Date reported
*
-
Month
-
Day
Year
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DETAILS OF PROPERTY
List items that have been damaged, lost, or stolen
*
Is the property repairable?
*
Yes
No
If so, please attach quote/s for the repairs/replacement
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THIRD PARTY DETAILS
Do you know who was responsible for the damage?
*
Yes
No
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Other details
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SETTLEMENT DETAILS
Account name
BSB
Account Number
Are you registered for GST?
*
Yes
No
ABN
Please verify that you are human
*
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