property insurance claim report

Transcription

1 property insrance claim report

2 CGU Insrance Limited ABN Please retain this page for yor information Abot yor claim Most policies allow for replacement of property with the nearest eqivalent available or a cash settlement. Valation figres and sms insred for jewellery and some other items are not agreed cash settlement amonts. They are maximm limits on the amont which may be claimed. Claims for jewellery and some other items are sally settled by replacement. We will advise yo how we will settle yor claim. We will contact yo as qickly as possible abot yor claim. For many claims we will check the circmstances and damage before we athorise and pay for repairs. We may appoint a loss adjster or investigator or contact yo for more information. Please ensre yo answer the GST qestions at Q. 3 & Q. 14. Do not athorise repairs yorself If possible, retain any damaged items, as we may need to inspect them before settling yor claim. Please attach an original qotation for repair or replacement of items. Qotations for replacement mst be for property of eqivalent style and qality to that which was lost or damaged or stolen. If possible, please attach proof of prchase, if items are no longer available for inspection. Please refer to yor policy booklet for more information abot how yor claim will be handled. If yo have any qestions abot yor claim, please contact yor local CGU Insrance office. The telephone nmbers are: Adelaide (08) Perth (08) Brisbane (07) Sydney (02) Lanceston (03) Ballarat (03) Melborne (03) Newcastle (02) How yo can resolve a dispte with s Or dispte resoltion system is free and works like this: 1. Please advise the staff at yor local CGU Insrance office (phone nmbers above) if yo are dissatisfied with: or decision on yor claim, or handling of yor claim, the services of or loss adjster or investigator. 2. The staff member will try to resolve the problem. 3. If nable to resolve it, the staff member will refer it to the spervisor or manager for attention. A decision concerning yor complaint will be made within 15 bsiness days of receipt. 4. If this fails to resolve yor problem, yo may reqest that the problem be referred to or internal dispte resoltion staff. They will investigate the dispte and try to reach a satisfactory otcome with yo, normally within 15 bsiness days of the date yo reqested a referral. 5. If yo do not accept or decision, yo may take the problem to the Financial Ombdsman Service (FOS), for an independent investigation. The FOS can assist with private consmer and some small bsiness type claims. The telephone nmber for the Financial Ombdsman Service is More detailed information abot this process is available from yor local CGU Insrance office.

3 CGU Insrance Limited ABN Property Insrance Claim Report For loss, theft, fire, glass, impact and other damage claims This form is for making claims for lost, stolen or damaged property. If yor claim is for a motor vehicle, personal injry or illness or machinery, or if it is a claim on a travel policy, yo need a different form. Ask or agent, yor broker or yor local CGU Insrance office for the right one. Please answer all qestions. This will help s process yor claim qickly. If yo need more space to answer any of the qestions, please se a separate sheet of paper. Any attachments will form part of this claim report and the declaration will inclde them. Ring yor local CGU Insrance office to see if yor claim can be settled by or Rapid Repair or QUICKGlass service. 1. Policy no. (from yor schedle) : : : : : : : : : : : Expiry date 2. Insred (srname, company or partnership) Given name(s) of insred Contact person (for company or partnership claims) Occpation 3. Are yo registered for GST prposes? What is yor ABN? : : : : : : : : : : Have yo claimed or do yo intend to claim an inpt tax credit on the GST applicable to this policy? 4. Address Is the amont claimed or intended to be claimed less than 100% of the GST applicable to the premim? Specify the percentage amont claimed or intended to be claimed % 5. Private telephone no. Bsiness telephone no. Facsimile no. ( ) ( ) ( ) 6. When did the loss, theft or damage happen? Date Time a.m. 7. Please describe what happened. p.m.

4 8. Address where loss, theft or damage happened Are yo the only occpier of yor premises? Please give details 9. Who discovered the loss, theft or damage? Name of person Date discovered Time a.m. p.m. 10. Do yo know who is responsible for the loss or theft of, or damage to yor property? Name(s), address(es) and any other information abot the person(s) responsible 11. Were there any witnesses to the loss, theft or damage? Name of witness Address Name of witness Telephone no. ( ) Telephone no. ( ) Address 12. Were yor premises broken into? When were the premises last occpied? Date Time a.m. p.m. Were the premises secrely locked? How was entry gained (e.g. window broken, door forced)? Have steps been taken to improve the secrity of yor premises? Yo mst report any loss, theft or vandalism of property to the police. We may need to apply to the police for a copy of this report. 13. Name of police station where yo reported it Name of police officer Police offence report no. Date reported Yo mst report any loss cased by fire to the brigade. Name of fire station where yo reported it Date reported

5 14. Please list the details of yor lost, stolen or damaged property. Item. Describe flly each item lost, stolen or damaged Owner of the item Description of items Name and address of person/company from whom the item was received or prchased, if known Month/Year received or prchased Prchase price Only complete this colmn if the items being claimed for are sed in connection with yor GST registered bsiness. Inpt tax credit yo can claim on the repair or replacement of these items as a % of the total GST payable. Amont claimed If yo need additional space, please attach a list describing each item. After completing Description of items please contine on the next page. Total

6 15. Is the property repairable? 17. Some of the property lost, stolen or damaged may be covered nder other policies, inclding health insrance. Please list any other insrance yo have which might cover these items. Name of the insrer Attach a qote for the repairs. Attach original receipts, valations, qote for replacement or a certification from an athorised repairer that the item is nrepairable. 16. Do yo owe money on the property lost, stolen or damaged? Lender s name Address Policy no. Approx. amont owing Type of insrance Address 18. Have yo had any previos losses or made any claims for loss, theft or damage on any insrer in the past five years, whether yo claimed for them or not? Tell s what happened Vale Date of loss 19. Has any insrer refsed or cancelled cover or reqired special terms to insre yo? Tell s what happened Insrer 20. Have yo been charged with, or convicted of, any criminal offence in the last 10 years? State details

7 Declaration Declaration I declare that to the best of my knowledge and belief the information in this form is tre and correct and I have not withheld any relevant information. I consent to CGU Insrance sing my personal information I have provided on this form for the prpose of processing my claim. I nderstand that if I choose not to provide the reqired details, this is my choice, however, CGU Insrance may not be able to process my claim. * I consent to CGU Insrance disclosing my personal information to other insrers, an insrance reference service or as reqired by law. I consent to CGU Insrance also disclosing my personal information to and/or collecting additional information abot me, from investigators or legal advisers. Signatre of insred or person with athority to sign for and on behalf of a company or partnership Date * This consent only applies when a claim is sbmitted in relation to a policy issed to the individal, not a company or bsiness. Please indicate the nmber of additional pages attached to this claim report When complete, please forward the report to: CGU Insrance, GPO Box 9902 in the capital city of yor state, or or agent or yor broker, or yor local CGU Insrance office.

8 HOC0051_pdate REV3 11/08 Insrer CGU Insrance Limited ABN