INSURANCE CLAIM FORM
This is a declaration of loss  to help us lodge a Body Corporate insurance claim  on your behalf.

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Building Name

 
Address at which the loss/damage occurred *

 
Applicant's Status *


 
Applicant's name *

 
Applicant's phone number

 
Date of Loss *

 
Time of Loss *

 
Particulars of event causing damage *

 
Who is the onsite contact?

eg. caretaker, owner, strata manager
 
Phone number of the onsite contact

 
Were there any witnesses to the loss, theft or damage? *

     
 
Provide the name and contact number of the witness who discovered the loss / witnessed the event.

Fill this out if you ticked 'YES' to question 12.
 
Have the police been notified? *

YES is required for all malicious damage/burglary claims.
     
 
Provide the station & officer and date of the police report:

Fill this out if you ticked 'YES' to the "Has the police been notified ?" question
 
Details of the person causing damage (if applicable)

Please provide there name, address, contact number, vehicle registration number and vehicle insurance.
 
Please upload any documents or pictures associated with this claim.

 
Important Notice and Declaration

Please note in the event that the claim is not accepted by the insurer, the Body Corporate may be responsible for the
payment of repair cost to the Builder/Repairer if they are liable for the rectification of the damage under the governing legislation.

I hereby declare the above statements and particulars to be true and correct and I make this declaration on the basis 
that I have delegation of power to sign for and on the behalf of the Insured.

The completion of this application is a form of electronic signature and it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding. *

This has been made by a legal representative of the Lot in particular to this claim.
     
Thank you for taking the time to fill out this insurance claim form. We will be in touch.

Team Community Co.
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