AIS Insurance PTY LTD. Specialising in Service
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New Claims Report - Property:  
   
Date:
Time:
Insurer:
Policy number:
Insured name :
Postal address
Phone number
Mobile:
***Client must agree that all information supplied to us is true and correct in every detail.***
If registered for GST, ABN no
%ITC

Type of claim : Burglary, fusion, water damage, glass, storm etc

Date of loss:
Where did the loss or damage occur:   
How did damage/loss occur?
Has damage been repaired? - Yes/No
If yes, has invoice been paid? - Yes/No
 
If Burglary - Police report number :
Police station:
Telephone number:
Date notified:
Officer name:
How were premises entered?
 
If damage is result of fire. Did fire brigade attend? - Yes/No
 
If fusion. Type of appliance and age of unit : - Yes/No
***Full report from Electrical Contractor to be supplied.***
If swimming pool pump, is the pool above ground? - Yes/No

 
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