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Strata Claim

STRATA INSURANCE CLAIM FORM
Please complete the below fields, providing as much information as possible.

This will assist the insurer in processing your claim.
Insured Details
Insured Name and Plan Number:
Owners Corp Secretary details (name, email and phone number):
Full address where loss occurred (please list if common area or units have been affected):
Date of loss:
Policy number and name of Insurer:
Are you GST registered ?*
- Yes
- No
If yes, please provide your ABN number and ITC percentage:
Payment Details
Bank details must be provided below.
Account Name:
BSB:
Account Number:
Access Details
If an assessor is appointed, access to the premises may be required.

Please list the name and contact details of the relevant person who can facilitate access.
Contact name:*
Contact details (phone number and email address):*
Loss Details
Nature and detailed description of damage (details of loss):
Cost Details
*
Items claimed (e.g. make safe, repairs, etc.): Amount:
Quote/Invoice Attached?*
- Yes
- No
Attachment:
Third Party Details
If the Loss was caused by malicious damage, impact damage, vandalism or theft, please complete this section.
Police report number (if applicable):
If you know the details of the responsible third party who caused the damage, please provide their details (name, address and phone number):
Declaration
I hereby declare that the information contained within this document is true and correct and I make this declaration on the basis that I have been delegated power to sign for and on behalf of the Owners Corporation.
Full Name:*
Signature:*
Date:*
Contact number:*
If you have any queries, please contact us on 02 9299 0767.
*
I hereby declare the statement and particulars I make on the following page to be true and correct and I make this declaration on the basis that I have delegation of power to sign for and behalf of the insured.
Phone
This field is for validation purposes and should be left unchanged.

Landlord Claim

RESIDENTIAL LANDLORDS PROPERTY INSURANCE CLAIM FORM
Please answer all relevant questions and attach a separate sheet if more space is needed
PURPOSE
Name of Insured:*
Trading as:*
Contact Person*
Contact number:*
Email address:*
Postal address:*
GST DETAILS
Is the insured registered for GST purposes?*
- No
- Yes
If yes, provide insured’s ABN:
Has the insured claimed (or can claim) an input Tax Credit for the GST on your insurance policy?*
- No
- Yes
If yes, provide the amount the insured intends to claim if less than 100%:
CLAIM DETAILS
(NB. You must report any loss, theft or vandalism to the police. We may need to apply for a copy of your report.)
Address where the loss/damage occurred:
Date of loss:
Brief description of what happened:
Is a third party responsible for the loss/damage (including a tenant)?*
- No
- Yes
If yes, who?
Please advise contact details, including that of any witnesses:
Were the police notified?*
- No
- Yes
If yes, please provide the following details.
Police report number:
Police officers name:
Station:
Date:
What was the method of entry and exit to/from the premises?
What other action was taken to reduce your loss?
List of items lost, damaged or stolen
If you need more space, please attached a separate sheet showing the information below for each item.
*
Full description of each item lost, damaged or stolen Month/Year Purchased or acquired Original purchase price ($) Input Tax Credit you can claim as a % of the total GST Amount ($) claimed
Total:
Do you own the items listed?
- No
- Yes
Provide details of any other interested party (e.g. Mortgagee):
A) If the damaged item is repairable, please attach two original quoted for repair
B) If the damaged item is unrepairable, attach the original receipt, valuation, quotes for replacement or certification from an authorised repairer that the item is unrepairable.
C) Photographs of the damaged property should also be supplied to us if available
LOSS OF RENT DETAILS
(Please attach the residential lease applicable to the claim)
Reason for loss of rent:
Name and contact address of tenant (or forwarding details if known):
Has the term set out in the original lease to the Tenant expired?
- No
- Yes
Has the Tenant given you or your managing agent, notice of intention to vacate?
- No
- Yes
If Yes, please attach a copy of the notice
Have notices to vacate been issued to the Tenant?
- No
- Yes
If Yes, please attach a copy of the notice(s)
Has a claim been lodged with any Tenancy Tribunal?
- No
- Yes
If Yes, please attach a copy of the claim(s)
What date did the Tenant move into the premises?
What date did the Tenant vacate premises/return keys?
Until what date has the tenant paid rent?
Bond amount:
Has the Bond been claimed?
- No
- Yes
If no, why not?
Have the premises been re-let?
- No
- Yes
If no, why not?
If Yes, attach a copy of the new residential lease)
AMOUNT OF CLAIM FOR LOSS OF RENT
Date from:
Date to:
Weekly rental amount:
CLEANING AND RE-LETTING* EXPENSES SHOULD BE DEDUCTED FROM THE BOND AS FOLLOWS
PAYMENT DETAILS
Do you want payment to be made by electronic funds transfer?
- No
- Yes
If Yes, provide the payee’s bank details
Bank name:
Bank branch:
Account Name:
BSB:
If no, who should the settlement cheque to be made payable to?
Attachments
Drop files here or
This claim is being made against Chubb Insurance Australia Limited ("Chubb") which may be contacted by calling 02 9273 0100 to receive information on the closest Chubb office. Chubb reserves the right to contact either the insured or Honan Insurance Group directly or indirectly to gather any further information Chubb may require as part of the claim review process. Any information provided to Honan Insurance Group or Chubb will be subject to Chubb's Privacy Policy, which may be found at www.chubb.com.
DECLARATION
(lf a firm / company, the following declaration must be made and signed by a member of the firm, so describing him self / herself) I/We declare that the above answers are true and correct to the best of my/our knowledge and that I/we have not withheld any relevant information that may affect the claim. I/we consent to Chubb Insurance Australia Limited using my personal information provided on this form for the purpose of processing my claim.
Signed:
Date:
Full name:
Position (if a firm/company):
For Office Use Only - To Be Completed By Honan Insurance Group
Policy number:
Period of Insurance:
Date Premium paid:
Print name:
I hereby declare the statement and particulars I make on the following page to be true and correct and I make this declaration on the basis that I have delegation of power to sign for and behalf of the insured.
Name
This field is for validation purposes and should be left unchanged.