Contents Claim Form

Contents Claim Form (Domestic Only)

When your belongings are damaged, lost, or stolen, we’ll help you get them repaired or replaced as quickly as possible. From lost devices and water-damaged items to smoke damage or home burglaries – we’re here to back you up.
Policy Holder Details
Name*

First NameLast Name
Email*
example@example.com
Insured Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Has the policyholder ever had an insurance policy declined, or had special terms imposed?*

YesNo
Has the insured or any member of the insured’s family living with them, (nominated driver) any person or entity to be covered by this insurance, ever been charged, or convicted of any criminal offence other than driving offences?*

YesNo

Loss Details
Please list all items that were lost/damaged/stolen?*
Are any of these items used for business, trade, or professional purposes? Please specify which items are listed above.
Bank details for settlement
Supporting Documents (images, proof of purchase, quotes)

Cancelof
Should be Empty: