Fillable Commercial Domestic Claim Notification Form MAR May 2017 Fill In (Australian National University)

Fill Online, Printable, Fillable, Blank Commercial Domestic Claim Notification Form MAR May 2017 Fill In (Australian National University) Form

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Commercial Domestic Claim Notification Form MAR May 2017 Fill In (Australian National University)

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The Commercial Domestic Claim Notification Form MAR May 2017 Fill In (Australian National University) form is 1 page long and contains:

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  • 24 check-boxes
  • 31 other fields

Country of origin: AUSTRALIA
File type: PDF

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C:\Users\jdibben\Dropbox\Common Documents\Claims\MARKEY\Commercial Domestic Claim Notification Form MAR May 2017docx.docx
1.
Company/Insured Name
2.
ABN No.
ITC%
3.
Contact Name
Contact Phone No.
Email Address
4.
Address of Loss
5.
Date of Loss
Time
am pm
6.
Description of Loss
7.
Reported to Police (YES OR NO)
Yes No Station? __________________________________
Event No. ________________________________________________
8.
Additional Notes:
9.
Bank Account Details
Name ___________________________________________________
BSB ________________ Account No. _________________________
10.
Claim Range Estimate
$ ____________ or 1-5K 5-30K 30-50K
50-100K 100-200K over 200K
OFFICE USE ONLY
11.
Client No.
Claim No.
12.
Policy No.
Insurer
13.
Claim Lodged with Insurer?
Yes No If yes, how? Email Mail Telelodge
Claim Form sent to Client?
Yes No If yes, how? Email Mail Delivered
14.
Who is the Builder/Assessor allocated if telelodged (if known)?
_____________________________________________________________________________________
15.
Is the claim registered
on CBS
Yes No Who registered it? ________________________
16.
Your Name
Date
17.
Allocated Claims Servicer
Broking Team Claims Team
COMMERCIAL & DOMESTIC
CLAIM NOTIFICATION FORM
(ALL ANSWERS MUST BE COMPLETED)
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Commercial Domestic Claim Notification Form MAR May 2017 Fill In (Australian National University)

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Completed 28 April 2021

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