Landlords Claim Form - Allianz
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4Landlords Claim Form
Landlords
Intermediaries
The supply or acceptance of this form is not an admission of
liability on the part of Allianz.
Claim Number
Name of Insured:
Contact Person
Home Phone No.
Work Phone No.
Mobile No.
Email
Occupation
Postal Address
Postcode
Broker/Agent Name
Phone No.
Policy No.
Excess $
Inception Date
Expiry Date
Interested Parties: Is the property being claimed for under a Financial Agreement?
Yes
No
Name of Financier
Contract No.
G.S.T.: Are you registered for GST purposes?
Yes
No
A.B.N.
%
To what extent are you entitled to claim an Input Tax Credit on the GST for this policy?
Managing Agent details
Name of managing agent
Contact person name
Telephone number
(
)
Facsimile number
(
)
Documentation required
Attached
• Documents to establish loss (eg. receipts, invoices, quotes, etc)
• Residential Lease, current at the time of loss
• Commencement and termination inspection reports
• Tenancy application form
• Copy of Bond Authority receipt of bond refund
• Copy of tenant rental ledger
• Copy of any notices issued to the tenant
• Copy of tribunal/court ruling
• Copy of the new Lease (to confirm re-lease date)
Rent Loss details
Full name of tenant/s (Surname, Company, Partnership)
Given name/s
Contact person in company
Tenant’s forwarding address
Street number/name
Town/suburb
Postcode
Tenant’s Driver’s Licence or Passport number
Driver’s Licence number
State
Passport number
Country of issue
Allianz Australia Insurance Limited AFS Licence No. 234708 ABN 15 000 122 850 Registered Office: 2 Market Street Sydney NSW 2000
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Parent category: Business