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Select the type of insurance you are claiming for below

Business - Machinery Breakdown

Claim Form - Machinery Breakdown

Name of Insured(Required)
Address Where Incident Occurred(Required)
Do you consider any other party responsible for the loss?
Are you the sole owner of the property lost or damaged?
Is the motor under a manufacturers warranty?
Details of Damaged Items(Required)
Item Damaged
Purchase Date
Replacement Value
 
Name of Repairer
Consent(Required)
Name(Required)
Drop files here or
Max. file size: 128 MB.

    Business - Motor Vehicle & Plant Machinery

    Claim Form - Motor Vehicle

    Name of Insured(Required)
    Address Where Incident Occurred(Required)
    Please provide images of the damage
    Accessories and/or Modifications
    Description
    Value
     
    Name of Driver(Required)
    Has the driver's licence ever been cancelled?
    Has the driver been involved in previous accidents in the past three years?
    Was any intoxicating liquor and/or drugs (prescribed or otherwise) consumed by the driver in the 12 hours prior to the accident?
    Was a breathalyser, blood test or any other test requested?
    Was the incident reported to the police?
    Preferred Repairer
    Third Party's Details - Name
    Witness Details - Name
    Consent(Required)
    Name(Required)
    Drop files here or
    Max. file size: 128 MB.

      Business - Motor Vehicle Windscreens Only

      Claim Form - Motor Vehicle Windscreens Only

      Name of Insured(Required)
      Address Where Incident Occurred(Required)
      Has the windscreen been repairer/replaced?(Required)
      If YES, has the repair account been paid?
      If NO, have you found a repairer and has the repair been quoted?
      Consent(Required)
      Name(Required)
      Drop files here or
      Max. file size: 128 MB.

        Business - Personal Accident and Illness

        Claim Form - Personal Accident and Illness

        Name of Insured(Required)
        Is your claim for an accident or illness?
        For Accident Claims - Address Where Incident Occurred(Required)
        Witness Details
        Have you previously been treated for any serious injury?
        Have you had this complaint before?
        Was hospital treatment required?
        Hospital/Medical Centre Details
        Name
        Address
        Doctor's Name
         
        Is this doctor still treating you for the injury / illness?
        Is this doctor your regular doctor?
        Your Regular Doctor Details
        Is there any condition (past or present) affecting your current disability?
        Are you now:
        Have you made, or will you make, a claim for benefits under any Workers’ Compensation Act or Transportation Act because of this injury?
        Are you entitled to claim benefits for this Injury / Illness from other Insurers, Persons, Company, Health Fund, Friendly Society or Government?
        Consent(Required)
        Name(Required)
        Drop files here or
        Max. file size: 128 MB.

          Business - Property Damage

          Claim Form - Property Damage

          Name of Insured(Required)
          Address Where Damage Occurred(Required)
          Description of Property Lost or Damaged(Required)
          Description
          Date of Purchase
          Replacement Value
           
          Witness Details
          Consent(Required)
          Name(Required)
          Drop files here or
          Max. file size: 128 MB.

            Business - Public Liability & Professional Indemnity

            Claim Form - Liability

            Name of Insured(Required)
            Address Where Incident Occurred(Required)
            Were there any witnesses?
            If Yes, please provide details below
            Did the police attend the accident/incident?
            If Yes, please provide details below
            Officers Name
            Property Details - describe the property that was damaged
            Item
            Replacement Value
             
            Name of Injured Person
            Address of Injured Person
            What medical assistance is necessary?
            Consent(Required)
            Name(Required)
            Drop files here or
            Max. file size: 128 MB.

              Business - Theft & Money

              Claim Form - Theft & Money

              Name of Insured(Required)
              Address Where Damage Occurred(Required)
              Description of Property Lost or Damaged(Required)
              Description
              Date of Purchase
              Replacement Value
               
              Officers Name
              Witness Details
              Consent(Required)
              Name(Required)
              Drop files here or
              Max. file size: 128 MB.

                Business - Transit

                Claim Form - Transit

                Name of Insured(Required)
                Freight Damaged
                Freight Description
                Quantity
                Invoice Value
                Replacement Cost
                 
                Name of Driver
                Was the vehicle driven with the insured’s consent?
                If No, further details will be required
                Was the freight being handled or controlled with the insured’s consent?
                If No, further details will be required
                Was any intoxicating liquor or drugs (including prescription drugs) consumed in the 12 hours preceding the accident or transit journey?
                If Yes, further details will be required
                Did the driver or person in control of the freight undergo a breathalyser / blood test?
                If Yes, further details will be required
                Was another vehicle/person involved?
                If yes, please provide further information
                Name
                Checklist of Important Documents
                Consent(Required)
                Name(Required)
                Drop files here or
                Max. file size: 128 MB.

                  Business - Travel

                  Claim Form - Travel

                  Name of Insured(Required)
                  Details of Medical Expenses Incurred
                  Date of Expense
                  Description
                  Amount
                   
                  Description of Property Lost or Damaged
                  Description
                  Replacement Value
                   
                  Was the incident reported to the police/authorities?
                  Have you incurred additional travel expenses?
                  Additional Expenses
                  Date of Expense
                  Description
                  Amount
                   
                  Have you been involved in a motor vehicle incident?
                  Driver's Name
                  Provide Details
                  Vehicle Excess
                  Repair Costs
                  Amount Being Claimed
                   
                  Consent(Required)
                  Name(Required)
                  Drop files here or
                  Max. file size: 128 MB.

                    Business Claim Form - Strata

                    Business Claim Form - Strata

                    Name of Insured(Required)
                    Name of Authorised Person(Required)
                    Your relationship to the insured(Required)
                    Full Name of Building Manager(Required)
                    Have repairs been undertaken?
                    If the repairs have not been completed, have you obtained quotations to repair the damage?
                    If the repairs have not been completed, have you obtained quotations to repair the damage?
                    Max. file size: 128 MB.
                    Max. file size: 128 MB.
                    Details of Items Damaged, Lost or Stolen
                    Description
                    Amount
                     
                    Was the incident reported to the police?
                    Is there a third party involved?
                    Third Party's Name
                    Consent
                    Name
                    Drop files here or
                    Max. file size: 128 MB.

                      Personal - Boat Insurance

                      Claim Form - Boat Insurance

                      Name of Insured(Required)
                      Type of Claim
                      Where did the incident occur?(Required)
                      Name of person operating the boat
                      Address
                      Is it alleged that any person involved in this incident was under the influence of alcohol or a drug?
                      Details of Items Damaged, Lost or Stolen(Required)
                      Description
                      Purchase Date
                      Replacement Value
                       
                      Was another party injured or their property damaged in this incident?
                      Name
                      Witness Details- Name
                      Consent(Required)
                      Name(Required)
                      Drop files here or
                      Max. file size: 128 MB.

                        Personal - Caravan Insurance

                        Claim Form - Caravan Insurance

                        Name of Insured(Required)
                        Modification and/or Accessories
                        Description
                        Value
                         
                        Type of damage sustained(Required)
                        Address where incident occurred(Required)
                        Have you ever lost your licence?(Required)
                        Have you ever had any traffic offences, fines or infringements?(Required)
                        Have you ever had any prior accidents and/or claims?(Required)
                        Did the police attend the accident scene(Required)
                        Were any liquor/drugs, prescriptive or non-prescriptive medication consumed 12 hours prior to the accident?(Required)
                        Description of Items Damaged, Lost or Stolen(Required)
                        Description
                        Amount
                         
                        Witness Details - Name
                        Third Party Details - Name
                        Consent(Required)
                        Name(Required)
                        Drop files here or
                        Max. file size: 128 MB.

                          Personal - Home & Contents

                          Claim Form - Home & Contents

                          Name of Insured(Required)
                          Where did the loss or damage occur?(Required)
                          Was another person responsible for the damage?
                          Name
                          Address
                          If damage is the result of fire, did the fire brigade attend?
                          If damage/loss is the result of burglary, were the police notified?
                          Please provided copies of tax invoices or repair quotes. Please advise if emergency repairs have already been completed
                          Consent(Required)
                          Name(Required)
                          Drop files here or
                          Max. file size: 128 MB.

                            Personal - Landlord Insurance

                            Claim Form - Landlord Insurance

                            Name of Insured(Required)
                            Where did the loss or damage occur?(Required)

                            Property Damage or Theft

                            If damage is the result of fire, did the fire brigade attend?
                            If damage/loss is the result of burglary, were the police notified?
                            Is another person responsible for the damage?
                            Name
                            Items Damaged, Lost or Stolen(Required)
                            Description
                            Purchase Date
                            Replacement Value
                             
                            Please provided copies of tax invoices or repair quotes.

                            Loss of Rent

                            Did the tenant give any notice to leave the property?
                            Was the tenant evicted by court order?
                            Has the property been re-let?

                            Tenant Default

                            Full name of defaulting tenant:
                            Tenant's forwarding address
                            Please advise if emergency repairs have already been completed.
                            Consent(Required)
                            Name(Required)
                            Drop files here or
                            Max. file size: 128 MB.

                              Personal - Motor Vehicle

                              Claim Form - Motor Vehicle

                              Name of Insured(Required)
                              Address where incident occurred(Required)
                              Please provide images of the damage
                              Modification and/or Accessories
                              Description
                              Value
                               
                              Name of Driver(Required)
                              Has the driver's licence ever been cancelled?
                              Has the driver been involved in previous accidents in the past three years?
                              Was any intoxicating liquor and/or drugs (prescribed or otherwise) consumed by the driver in the 12 hours prior to the accident?
                              If Yes, please provide details within the Additional Information section
                              Was a breathalyser, blood test or any other test requested?
                              Was the incident reported to the police?
                              Third Party's Details - Name
                              Witness Details - Name
                              Consent(Required)
                              Name(Required)
                              Drop files here or
                              Max. file size: 128 MB.

                                Personal - Motor Vehicle Windscreens Only

                                Claim Form - Motor Vehicle Windscreens Only

                                Name of Insured(Required)
                                Address Where Incident Occurred(Required)
                                Has the windscreen been repairer/replaced?(Required)
                                If YES, has the repair account been paid?
                                If NO, have you found a repairer and has the repair been quoted?
                                Consent(Required)
                                Name(Required)
                                Drop files here or
                                Max. file size: 128 MB.

                                  Personal - Residential Strata

                                  Residential Strata

                                  Name of Insured(Required)
                                  Name of Authorised Person(Required)
                                  Your relationship to the insured(Required)
                                  Full Name of Building Manager(Required)
                                  Have repairs been undertaken?
                                  If the repairs have not been completed, have you obtained quotations to repair the damage?
                                  If the repairs have not been completed, have you obtained quotations to repair the damage?
                                  Max. file size: 128 MB.
                                  Max. file size: 128 MB.
                                  Details of Items Damaged, Lost or Stolen
                                  Description
                                  Amount
                                   
                                  Was the incident reported to the police?
                                  Is there a third party involved?
                                  Third Party's Name
                                  Consent
                                  Name
                                  Drop files here or
                                  Max. file size: 128 MB.

                                    Personal - Travel

                                    Personal Claim Form - Travel

                                    Name of Insured(Required)
                                    Details of Medical Expenses Incurred
                                    Date of Expense
                                    Description
                                    Amount
                                     
                                    Description of Property Lost or Damaged
                                    Description
                                    Replacement Value
                                     
                                    Was the incident reported to the police/authorities?
                                    Have you incurred additional travel expenses?
                                    Additional Expenses
                                    Date of Expense
                                    Description
                                    Amount
                                     
                                    Have you been involved in a motor vehicle incident?
                                    Driver's Name
                                    Provide Details
                                    Vehicle Excess
                                    Repair Costs
                                    Amount Being Claimed
                                     
                                    Consent(Required)
                                    Name(Required)
                                    Drop files here or
                                    Max. file size: 128 MB.
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