Australia’s Leading Landlord Insurance Specialist
Claim form - storm/water damage
u
the property damage will exceed $2,000, you must call Terri Scheer Insurance Pty Ltd as we may need to appoint a loss adjuster.
If
Failure to do so may result in your claim being reduced or declined.
Real Estate Agent:
Phone: Facsimile:Email:
Landlord’s name:
Landlord’s phone:
Landlord’s email:
Address of property where loss or damage occurred:
Details of any other insurances on the property:
Tax status: Registered business
Yes
No
ABN:
Taxable %:
%
Storm or Water Damage
Description of loss:
How did the rain, hail or water enter the premises?
What rectification work or temporary repairs have been carried out?
Date of loss:
/
(Please note that the cost to repair the cause of the leak is not covered by insurance)
/
Document checklist
Tradesmen’s report that details what caused the leak and that it has been repaired.
Restoration invoice for the drying of any water damaged items.
Proof that damaged items are beyond repair if replacement is required.
2 quotes for the repair/replacement of the resultant damages.
Invoices required to finalise the claim on completion of the repairs.
Summary of costs
InvoiceAmount
$
Total loss claimed: $
$
Deduct excess applicable: $
$
Total claim: $
$
Payment options (please select one)
Cheque
EFT
Account name:
BSB:
Account number:
Declaration
I do hereby solemnly and sincerely declare the above statements and particulars to be true and correct and I make this true and solemn
declaration by conscientiously believing the statements and particulars contained above to be true in every particular.
Today’s date:
Signature:
Name in full:
© Terri Scheer Insurance Pty Ltd 2011. AAI Limited, ABN 48 005 297 807, AFS Licence No. 230859 is the insurer and issuer of our policies. TS00053 01/10/12 A
terri scheer® insurance pty ltd
ABN 76 070 874 798 AFS Licence No. 218585
GPO Box 1619 Adelaide SA 5001 Australia
p 1800 804 016
f 1300 370 874
e [email protected]
w terrischeer.com.au