Strata Insurance Claim Form
This form is to be completed for the lodgement of Strata Insurance Claims
Insured Name (OC/Strata Address) (Eg: SC12345)
If Applicable
Policy Number
If Applicable
Property Address
*
Unit / Apartment
Street Address
Suburb / Town
State
Post Code
Owner /Company & ABN
*
First Name / Company Name
Last Name / ABN
Mobile Phone
*
Format: 0000 000 000.
Email
*
Are you registered for GST
Please Select
Yes
No
Date of Loss
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Loss
Hour Minutes
AM
PM
AM/PM Option
Loss Details (must include all relevant details to lodge claim - registration numbers, location of loss, vehicle details, driver details including licence details, TP details etc)
*
Third Party Details - Name, Email and Contact Number, Registration Etc. If no Third Party write N/A
*
Quote for repairs attached
Please Select
Yes
No
Police Report attached
Please Select
Yes
No
Any witnesses
Please Select
Yes
No
Witness Details (if applicable)
Do you require an insurance assessor to attend?
Please Select
Yes
No
Bank Details for Settlement (BSB, Account Number and Account Name)
*
Additional Information
*
I/we authorise the nominated person listed herein to represent us/myself at the upcoming listed and by signing we provide authority for the nominated persons to transact business and make decisions on my/our behalf
Attached all relevant files for this claim
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