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ABN: 12 162 702 025 | AFSL: 444494

Property Claim

Your duty of disclosure

Before you enter an insurance contract, you have a duty of disclosure under the Insurance Contracts Act 1984. If we ask you questions that are relevant to our decision whether to insure you and on what terms, you must tell us anything that you know and that a reasonable person in the circumstances would include in answering the questions. You have this duty until we agree to insure you.

If you do not tell us something

If you do not tell us anything you are required to tell us, we may cancel your contract or reduce the amount we will pay you if you make a claim, or both. If your failure to tell us is fraudulent, we may refuse to pay a claim and treat the contract as if it never existed.

By proceeding you confirm you have read and understood this duty

    PAGE 1. INSURED DETAILS

    Insured Name

    Address

    Phone number

    Email address

    Policy number

    GST

    Are you registered for GST purposes?

    ABN

    Are you entitled to claim GST on replacement of your property?

    Please advise

    PAGE 2. LOSS DETAILS

    When did the loss happen?

    Where did it happen?

    Who discovered the loss

    Name

    Phone Number

    DETAILS

    Describe what happened

    Properties lost or stolen

    Item

    Value ($)

    Please select proof of ownership type

    Upload Supporting Documents

    All lost or stolen property needs to be reported to the police for your insurance purpose. Please report your loss on police link or your nearest police station

    Name of Station

    Date reported

    Police report no.

    PAGE 3. PAYMENT DETAILS

    To assist with prompt reimbursement, please provide your bank details

    Account Name

    BSB

    Account No.

    DECLARATION

    I/ We declare that the best of my/our knowledge and belief the information in this form is true and correct and I/we have not withheld any relevant information.

    I/we consent to the insurance company using my personal information I/we have provided on this form for the purpose of processing my claim. I/we understand that if I/we choose not to provide required details, this is my/our choice, however the insurance company may not be able to process my claim.

    I/we consent to the insurance company disclosing my personal information to other insurers, an insurance reference services or as required by law. I/we consent to the insurance company also disclosing my personal information about me, from investigators or legal advisors.

    Please add your Digital Signature here

    Date

    Name

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