Make a Claim claims If you are human, leave this field blank. Type of Policy Insurance type: Strata Insurance Machinery Breakdown Landlords Contents OtherOther End Section The Insured Name: ie. If Body Corporate please insert the name of the building, or if contents claim; insert the name of the insured parties. SP/CTS/OC Number: Situation/Address of the insured property: State: NSW QLD VIC WA ACT NT TAS SA TST Post Code: Contact Email: End Section GST Declaration Is the insured registered for GST? Yes No If yes, what percentage is the insured entitled to claim Input Tax Credits? ABN (11 digits): End Section The Insurer Policy Number: Company: Excess: Is there any other insurance on the property? Yes No If Yes, please provide details of the insurer/s and policy numbers: End Section What Happened Please explain how the damage occurred? Date of Loss: If the exact date of loss is not known please provide the date the damage was first discovered: End Section Did any Person/s cause the damage? (whether intentional or not) Did another person cause the damage? Yes No If Yes, please provide the following. Unit Owner Tenant End Section Other: Please Complete: Name: Other: Title: Address: Contact Number/s Business Hours: After Hours: Mobile: Description of vehicle (year, make and model If damage caused by impact please provide: Registration Number of Vehicle: Vehicle Owner's Name & Contact Details: Police Report Police must be notified when property is lost, stolen or maliciously damaged - please ensure that notification is made prior to the claim being lodged. Police Station: Officer's Name: Date Reported: Crime Report Number: End Section Contact Details Should an Assessment be Necessary Please provide the contact details of a person or persons who may be contacted in the case that a loss adjuster requires access to the premises Name: Title: Address: Contact Number/s: Business Hours: After Hours: Mobile: End Section What is being claimed? Please list the articles lost, stolen or damaged and the amount being claimed. Please include the description of property, date of purchase, original purchase price, replacement purchase price and amount being claimed. End Section Please provide any additional information relevant to the claim. e.g. other contacts or repair information: Name: Position: (i.e member of Body Corporate, Unit Owner, Body Corporate Manager, Building Manager, etc) Email Address: Supporting Documentation Please attach any supporting documentation: End Section DECLARATION I declare that to the best of my knowledge and belief the information in this form is true and correct and I have not withheld any relevant information. I consent to BCB using the personal information I have provided on this form for purposes of processing my claim and in accordance with BCB's Privacy Policy. Where I have completed this form as a representative of another person, I confirm that person has authorised me to disclose their personal information included on this form and for that information to be used for purposes of processing their claim and in accordance with BCB's Privacy Policy. I understand that if I choose not to provide the required details my claim may not be able to be processed. I agree Yes No Date End Section
