General Insurance Claim

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General
Insurance
Claim
Insurer:
Policy No.:
Date Due:
Details of claim
Insured:
Are you registered for GST purposes? q No q Yes
¨¨¨¨¨¨¨¨¨¨¨
Do you have an ABN? q No q Yes
What is the GST percentage amount claimed:
%
Address at which loss/damage occurred:
Date of Loss:
/
/
Time of Loss:
:
Particulars of event causing damage:
Description of items lost/damaged:
Contact Person:
Contact Number:
Have police been notified? q No q Yes (YES is required for all malicious damage/burglary claims)
If YES, which station & officer?
Date Reported:
Details of person causing damage (if applicable)
Name:
Address:
Contact Phone No.:
Vehicle Registration No.:
Vehicle Insurer:
1300 854 251
.au

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