Marine Claim Form

Marine Claim Notification Form

Simply fill out the claim notification form below and one of our claims specialists will be in contact with you shortly.

Fields marked with an * are required

Please indicate if you are the broker or the policy holder? *

BrokerPolicy Holder

Broker First Name *

Broker Last Name *

Broker Email *

Insured Client Code (WinBEAT or Insight) *

Insured Contact Details

First Name *

Last Name *

Email Address *

Phone *

Policy Number

Insured Person Name or Business Name

GST Registered?

YesNo

ABN

Input Tax Credit (ITC) Percentage?

Claim Details

Loss Details

Date of Loss / Incident *

Loss / Incident Location

Third Party Name (if applicable)

Third Party Address (if applicable)

Brief description of claim (includes cause of loss or damage) *

Detailed Breakdown of Claim

Full description of item (eg. make, model, age) 2

Details of loss / damage

Sum Insured

Amount Claimed

Details of the Transit

Journey from

Journey to

Date

Carriers Name

Carriers Contact Number

Type of Transport

Own VehicleRoad CarrierRailPostSeaAir

Details of the Goods

Who is the owner of the goods?

Did any other insurance cover the goods at the time of loss?

If goods are damaged, where can they be inspected? Please advise contact name and number)

Have the police been notified?

YesNo

Police Station

Incident Number

Date reported

Broker comments to claims staff

Additional Comments

Upload Supporting Documents or Files

Please upload any documents that are required to support your claim. For example, letter of claim on carrier/ship/airline, invoice showing value of goods claims, freight invoice etc.

File Upload 1

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File Upload 2

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File Upload 3

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Do you have additional files to upload?

YesNo

File Upload 4

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File Upload 5

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File Upload 6

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Signature

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