AiS Insurance Pty Ltd - Specialising in Service - Member of Steadfast Group Limited

New Claims Report - Property:

Date:
Time:
Insurer:
Policy number:
Insured name :
Postal address
Phone number
Mobile:
*Client must agree that all information supplied to us is true and correct in every detail.*
If registered for GST, ABN no
%ITC
Type of claim : Burglary, fusion, water damage, glass, storm etc
Date of loss:
Where did the loss or damage occur:
How did damage/loss occur?
Has damage been repaired? - Yes/No
If yes, has invoice been paid? - Yes/No

If Burglary - Police report number :
Police station:
Telephone number:
Date notified:
Officer name:
How were premises entered?

If damage is result of fire. Did fire brigade attend? - Yes/No

If fusion. Type of appliance and age of unit : - Yes/No
*Full report from Electrical Contractor to be supplied.*
If swimming pool pump, is the pool above ground? - Yes/No