Photographic Equipment Claim Form

To lodge a Photographic Equipment Insurance claim, simply answer all questions outlined in the form below. Our team will then be in touch shortly to discuss.

All fields marked with an * are mandatory.

Insured's Details

Full Name *

Policy Number *

Contact Number *

Occupation *

Are you registered for GST? *

YesNo

ABN *

ITC Proportion (%) *

Address *

Street address *

City *

State *

Postcode *

Are there any other Insurance's in force that would cover this in whole or in part? *

YesNo

Insurer *

Policy Details *

Are you the sole occupier of the premises where the loss occurred? *

YesNo

Please provide details *

Are you the owner of the property for which this claim is being made? *

YesNo

If no, please provide details *

Details of Loss or Damage

Date of damage *

Time of damage *

What was the date the loss / damage / occurrence was first noticed and reported to you *

What was the time the loss / damage / occurrence was first noticed and reported to you *

Place and/or premises where it occurred *

Please provide full details on how the loss, damage or accident occurred *

Please describe the nature of the damage or loss *

Responsibility / Witness

Was another person, in your opinion responsible for the loss or damage or cause of the occurrence? *

YesNo

Please provide details *

Was there a witness or witnesses to this event? *

YesNo

Please provide details *

Insurance History

Have you previously sustained loss or damage or caused damage or injury to third parties? *

YesNo

Please provide details *

Was an Insurance Company involved? *

YesNo

Please provide insurer and policy details *

Description of Property Lost or Damaged

Item Description *

Date Purchased *

Supplier *

Purchase Price *

Amount Claimed *

Burglary Theft or Malicious Damage

Are you claiming for Burglary, Theft, or Malicious Damage? *

YesNo

Please provide full details of method of entry *

Were the police notified? *

YesNo

Police Station *

Date notified *

Officer *

Report Number *

Why was it not reported to the police? *

Electronic Funds Transfer (EFT) Details

Would you like the benefit to be deposited directly into a financial institution account via EFT? *

YesNo

Account Name *

BSB Number *

Account Number *

Financial Institution *

Privacy Consent

I consent to Coverforce:

Collecting and using my personal information for the purposes of administering my claim, including investigating, assessing and paying any claim made by me or on my behalf. (If we do not collect this information we may not be able to process your claim.)
Disclosing my personal information to related entities of Coverforce, the insured (if not myself), other insurers and reinsurers, insurance reference bureaus, law enforcement agencies, investigators, lawyers, assessors, repairers, advisors and the agent of any of these, insurance broker, insurance agent or other intermediary, my employer or Australian Financial Complaints Authority (AFCA) for the purposes of administering my claim or providing a report.
I understand that a copy of the Coverforce privacy policy statement, including information about access, may be obtained via the Coverforce website here or by calling 1300 503 503.

I / We hereby declare that the forgoing particulars are true and correct in every respect.

Please sign here *

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Date signed *