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Property Loss or Damage Claim Form

Details of Loss

Include details of what has occurred, and what damage has been sustained

Type of Loss
Date and time of Loss
Day
Month
Year
Time
HoursMinutes
Was this reported to the Police
Yes
No

Property Damage or Theft of Goods

Include year purchased, make and model

Include year purchased, make and model

Include year purchased, make and model

Evidence

Please upload photos of any/all damage which has occured

TAILORED INSURANCE | Corporate Authorised Representative (No. 1237729) of Insurance Advisernet Australia Pty Ltd, AFSL No. 240549
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