General Claims Form

WIP: this will be a form.

  1. Your full name?
  2. Company Name
  3. Registered for GST (Yes / No)
  4. Tel #; Fax # and Email address
  5. Date of loss
  6. insuring class    (Drop Down Selection)
    1. Household / Landlords
    2. Motor Vehicle
    3. Business Insurance       
    4. Liability Insurance
    5. Marine Cargo / Transit   
  1. How did the loss occur?
  2. What property has been lost / damaged ?