Claim Form

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Claim Details

Date of Loss
Cause of Damage
Loss Description
Claim Amount

Make safe/Urgent repairs – receipt/invoice ($)
Resultant Damage Quote ($)
Police Report Attachment

(Please attach in case the cause of claim is burglary, malicious damage, vandalism, graffiti. Insurers want to see if Third Party details are unknown)

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Third Party Details

Payment Details

OC Number

Claimant Number

FENCE CLAIM

GST Registration

OC#

CAUSE REPORT