Fillable SCHEDULE OF DAMAGED CONTENTS (Earthquake Commission New Zealand)

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SCHEDULE OF DAMAGED CONTENTS (Earthquake Commission New Zealand)

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Country of origin: NEW-ZEALAND
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SCHEDULE OF DAMAGED CONTENTS
Signed
Items with a Replacement Value of $500 or more must be supported by a quote/valuaƟ on.
Customer name:
Schedule of contents at address:
Email:
Phone:
Claim number:
Customer declaraƟ on:
The details given in respect of this claim are true and accurate;
I have not withheld any material informaƟ on;
I will inform EQC if any informaƟ on provided later becomes incorrect; and
I will provide any further informaƟ on required for EQC to assess this claim.
I declare that:
Dated
Remember to include your deposit slip
Quantity Description/comments
(including size, make/model & serial no.)
Purchase
price
Age
(years)
Replacement
value ($)
Offi ce
use
CLM/201
email to: claims@eqc.govt.nz
or;
Post to: Contents Team, EQC PO Box 311, Wellington 6140
Page 1 of
You cannot save data typed into this form.
You must print and sign the form before sending it to EQC.
Total
$0.00
Print
SCHEDULE OF DAMAGED CONTENTS continued
Items with a Replacement Value of $500 or more must be supported by a quote/valuaƟ on.
Claim number:
Customer declaraƟ on:
The details given in respect of this claim are true and accurate;
I have not withheld any material informaƟ on;
I will inform EQC if any informaƟ on provided later becomes incorrect; and
I will provide any further informaƟ on required for EQC to assess this claim.
I declare that:
Remember to include your deposit slip
Signed
Dated
Page 2 of
Quantity Description/comments
(including size, make/model & serial no.)
Purchase
price
Age
(years)
Replacement
value ($)
Offi ce
use
CLM/201
Total
$0.00
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SCHEDULE OF DAMAGED CONTENTS (Earthquake Commission New Zealand)

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Completed 27 November 2020

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