Make a claim

Please select the the type of policy that you wish to make a claim against

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Any loss involving malicious damage, lost or stolen property must be reported to the police

Please detail what has been lost/stolen/damaged and estimate value to repair/replace

Particulars Amount Claimed

Fusion/Power Surge Claims

Burglary Claim

Police

History

Vehicle Details

Incident Details

Driver Details

Third Party Details

Please note: Driver's full name, contact number, residential address, registraion, and license number is required for not at fault accidents.

Declaration

By submission of this claim for, you acknowledge and accept the following Declarations

Privacy The Privacy Act and the Australian Privacy Principles require your insurer to tell you that they collect your personal and sensitive information in order to calculate your loss and entitlements, determine their liability, compile data and handle claims. When handling claims, they may have to disclose your personal and other information to Insurance Reference Services (IRS), etc. or other parties as required by law. By reading and acknowledging the Adroit privacy collection notice you consent for us to proceed with submitting this information to your insurer. You have to right to seek access to your personal information and to correct it at any time. Please contact us on (03) 5244 7813, 8:45am - 5:15pm, Mon-Fri and advise the changes.

Declaration I/We certify that the information given in this form is truthful, accurate and complete. No information likely to affect this claim has been withheld. I/We understand that this claim may be refused if information is untrue, inaccurate or concealed. I/We acknowledge that I/We have read and understood the privacy information of all persons affected by this claim. I/We acknowledge that if I/We do not agree to the collection of this personal and sensitive information then the Insurer will be unable to process my/our claim.