Landlords Residential Property Claim Report printable pdf download

Landlords Residential Property Claim Report

for Loss, Theft, Fire, Glass, Impact and Other Damage Claims

Applicant Details

1. Policy no. (from your schedule)

Expiry Date ____/____/____

2. Name of insured

Telephone no.

(

)

Real Estate Agent

Telephone no.

(

)

Postal address

Postcode

3. Are you registered for GST purposes?

Yes

What is your ABN?

Have you claimed or do you intend to claim an input tax credit on the GST applicable to this policy?

Yes

Is the amount claimed or intended to

Yes

Specify the percentage

be claimed less than 100% of the

amount claimed or

GST applicable to the premium

intended to be claimed

Damage Report

1. Address or premises where loss or damage occurred

Postcode

2. Your claim may be the result of several different events. Each event will be treated as a separate

claim and each claim will attract the policy excess.

Please list below all separate identifiable events including the date that each event occurred.

Date of event

Nature of damage or loss

For example, a number of spillages in a room – each spillage is a separate event attracting a separate

excess.

3. Was the tenant responsible for any of the loss or damage?

Yes

please provide details.

Landlords Residential Property Claim Report