General Insurance Claim

  • Select date MM slash DD slash YYYY
  • Description of loss or damage

  • To assist in assessing the loss, the following information is requested.
  • Description 1
  • *Please show the Input Tax Credit you are entitled to claim on the purchase of each item as a percentage of the total GST payable.
  • Description 2
  • *Please show the Input Tax Credit you are entitled to claim on the purchase of each item as a percentage of the total GST payable.
  • Description 3
  • *Please show the Input Tax Credit you are entitled to claim on the purchase of each item as a percentage of the total GST payable.
  • Details of Loss Damage or Occurrence

  • Responsibility/Witnesses

  • Insurance History

  • This field is for validation purposes and should be left unchanged.