Property Claim Form Page 2
Download a blank fillable Property Claim Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Property Claim Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2RESET FORM
■ ■
■ ■
Police: Have the Police been notified? (All Burglary/Theft/Malicious Damage claims must be reported)
Yes
No
Police Station
Reporting Officer
Police report No.
Date reported
Security: Give details of any extra precautions or security improvements taken since the loss
Give details of any other action taken to recover or reduce your loss
■ ■
■ ■
Third Parties: Do you know who was responsible for the damage?
Yes
No
Name
Phone No.
Address
Postcode
Other details
(eg registration no.)
■ ■
■ ■
Witnesses: Were there any witnesses to the Event? Yes
No
(If yes, please complete the following)
Name
Phone No.
Postal Address
Postcode
Where was the Witness?
■ ■
■ ■
Other Insurance: Is there any other Insurance on the property? (consider Travel, Medical Insurances also) Yes
No
Name of Insurer
Policy details
History:
Have you had any insurance or renewal of insurance declined or cancelled or special conditions imposed
■ ■
■ ■
in the last 5 years?
Yes
No
■ ■
■ ■
Have you ever been convicted of or had any fines or penalties imposed for any criminal offence?
Yes
No
■ ■
■ ■
Have you suffered a loss or made a claim on a property related insurance policy in the last 5 years?
Yes
No
If yes to any history questions please give details
Privacy: The Privacy Act 1988 requires us to tell you that
external claims data collectors, investigators and agents
as an insurer we collect your personal and sensitive
or other parties as required by law.
information in order to calculate your loss and
You have the right to seek access to your personal
entitlements, determine our liability, compile data and
information and to correct it at any time. Please contact
handle claims. When handling claims, we may have to
us on 1300 360 529 EST 9am-5pm, Monday-Friday and
disclose your personal and other information to third
advise us of the changes.
parties such as other insurers, reinsurers, loss adjusters,
IDR Statement: Disputes are not an everyday
If you are not satisfied with the outcome of this process,
occurrence at Allianz. However we do provide an
we will advise you how to contact the insurance
internal dispute resolution process should any dispute
industry’s external independent complaints scheme
arise. Please feel free to ask for details.
(subject to eligibility).
Declaration: I/We certify that the information given in
consent to the collection, storage, use and disclosure of
this form is truthful, accurate and complete. No
personal and sensitive information of all persons
information likely to affect this claim has been withheld.
affected by this claim, with their approval. I/We
I/We understand that this claim may be refused if
acknowledge that if I/we do not agree to the collection
information is untrue, inaccurate or concealed.
of this personal and sensitive information then Allianz
I/We acknowledge that I/we have read and understood
will be unable to process my/our claim.
the Privacy Act 1988 information referred to above and
Signature of Insured
Date
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business