Home About us Forms News Events Gallery Contact Helpful Links

 

        
 
 
Business Insurance
Workers Compensation
Trades Insurance
Professional Indemnity
Public Liability
Other Insurance
 
Memberships and Partners
 
 
 
 
Pleasure Craft/Hull Claim Form
 
The Issue of this Form is not an Admission of Liability by Insurer
* = Required information   Policy #:
Please complete and return this claim form as soon as possible, so that your claim will receive prompt consideration by the Insurers.
The Insured
  * Company Name  
Name * Surname  
* Address
* Post Code    
* Occupation  
* Phone Private   * Phone Business  
Fax No. * Mobile  
* Email   * Contact Name  
* Are you registered for GST?
* What is your ABN?  
* Have you claimed an input tax credit on the GST amount applicable to this policy?
* Specify amount claimed:  %  
The Vessel/CRaft
Policy Due Date  dd/mm/yyyy  
Description of the Insured Vessel: Hull
Reg. No.
Motor
Serial No.
Trailer
Reg. No
Particulars of Loss/Damage
Date of Loss or Accident  dd/mm/yyyy  
Location at time of Loss or Accident
Describe purpose for which vessel was being used at time of Accident
Were you, as the Insured, in charge of the vesse ay time of Accident?
If not, who was in control?
Was the driver of the vessel licensed at the time of the Accident or Loss?
Have you or the person to whom the vessel was entrusted ever-suffered previous claim?
If yes, give details
Is there any other insurance on the Property under this claim?
Give details
If Property Stolen or Lost give date police advised  dd/mm/yyyy  
and the station (in all cases police must be advised immediately)
Is the Property under Hire Finance or otherwise encumbered?
Give details
Give details of Loss or Damage sustained and attach written quote of cost of repairs
Where can Insured Property be Inspected?
Describe how the loss, theft, damage and / or personal injury occured
Diagram of Circumstances. (Please include photos if available) boat
Particulars of Loss relating to road accident and / or third party damage on road or water
If claim is for Damage to Insured’s Property arising out of a Motor Vehicle Accident, the following details of Vehicle towing insured’s property are required
Make of Vehicle and Year
Reg. No.
If Vehicle Insured, Name of Insurance Co.
Policy No.
Driver at time of Accident
License No.
Address
Post Code
Details of other Vehicle involved in the Accident:  
Name of Owner
License No.
Address
Post Code
Name of Drivers
License No.
Address
Post Code
If vehicle Insured, Name of Insurance Company
Policy No.
Expiry Date  dd/mm/yyyy  
If this claim includes a claim for Personal Injury or Property Damage to a Third Party, the following details are required:
Third Parties injured (Name/s, Address/es, Age/s)
Owner of the other Vessel
Address
Details of other Vessel: Hull
Reg. No.
Make of Motor
Name of Insurance Co.
Name and Address of any hospitals, etc., or doctor who treated Third Parties
 

To avoid unnecessary delay in processing your claim, it is important that you attach documentation to support:

  • ownership of all property claimed, eg. Original invoices, owners manuals, photos, receipts, etc…
  • the repair / replacement of your loss. Eg. Original invoices, receipts, etc… by trade suppliers / repairers – itemising the precise nature of their quotation or work under taken eg. Size, model, type, age, hours, cost of labour, parts, prices…

Agree

Agree

Agree
 
 
Home    Forms    News    Events Gallery    Contact    Privacy    Copyright    Financial Sevices Guide
 
IPS - Suite 7-8 (first floor)
134 Main St - Osborne Park WA 6017
Phone: (08) 9340 5400 - Fax: (08) 9340 5411
Email: admin@ips.net.au 		SevenJay - Creative Design