Details of Event
For claims on the Owners Corporation Insurance the excess is payable by the claimant.
Address where event occurred
*
Building Name
Street Address
Suburb
State / Province
Postal / Zip Code
Nature and Cause of Damage
*
Date of loss
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Contact Details for Access
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Police Report Details
Please note a police report is only required if the claim has arisen from criminal activity and the owners corporation has received damage e.g. you experienced a break-in and a door or window is damaged.
Police Report Attached?
*
Yes
No
Police Report Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Third Party Details
Is the claim recoverable from a third party?
*
Yes
No
Third party name
First Name
Last Name
Third party Address
Street Address
Street Address Line 2
Suburb
State / Province
Postal / Zip Code
Third party Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Thiry party Email
example@example.com
Vehicle Registration (if applicable)
Vehicle Insurer (if applicable)
Invoices and Quotes
Please upload any invoices or quotes relevant to this claim.
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of
Declaration
*
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
Suburb
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Signature
*
Submit
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