Insurance Claim Information Sheet – All Strata Management Services

Owners Forms & Requests

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Insurance Claim Information Sheet

Please complete the form below to enable a claim to be lodged on your behalf for consideration by the insurance company. Please note that in the event that the claim is denied, and the damage is NOT to common property, any repairs carried out to the damage on your request will be your responsibility.

Address of Strata Property

Building Name

Unit Number

Street

Strata Plan No

If property has been stolen or damaged please complete the following:

1. What Was Damaged?

Damage

2. Date, Time of Loss/Damage

Date and Time

3. State The Circumstances

3a How did damage occur?

How Damage Occurred

3b Person/s Responsible?

Person Responsible

4. Repair Details

4a Have repairs been carried out?

Repairs done Checkbox

Yes No

Cost of repairs if already done.

Repairs $

If Yes to 4a Answer the next TWO Questions

4b Name of Repair Company?

Company Name

4c Has account been paid?

Repairs done Checkbox

Yes No

PLEASE ATTACH ACCOUNT *

Account copy

5. Malicious Damage Claims Must be Reported to Police (eg. Vandalism/Break-ins/Graffiti etc)

Police Station

Police Offence No:

6. Vehicle Impact Damage Claim Only

6a Name of Person who caused damage:

Name of Person

6b Address of Person who caused damage:

Address of Person

6c Make/Model & Registration of vehicle:

Make/Model & Rego

DECLARATION / AUTHORITY

I declare that the information given above is true and accurate.

Name

Title

Phone

Signed

Date