Property Claim Notifcation

Property Claim Notification

Company
This field is for validation purposes and should be left unchanged.
General Details
Which branch do you deal with?*
- Maroochydore
- Townsville
- Proserpine
- Mackay
- Ingham
Insured Name*
Contact Name*
Contact Number*
ABN
ITC %
Policy Details
Policy Number*
Section
Insurer
Excess
Loss Details
Date of Loss*
Time
Loss Description
List of damaged items*
Additional Documentation
Bank Details
Method
- Cheque
- EFT
Bank Name
BSB
Account Number
Account Name