• Landlords Insurance Claim Form

  • Format: 0000000000.
    • GST Details 
    • Is the insured registered for GST purposes?*
    • Has the insured claimed (or can claim) an input Tax Credit for the GST on your insurance policy?

  • Tenant Details

  • Has the term set out in the original lease to the tenant expired?*
  • If a new lease has not been agreed and signed, is the tenant occupying the premises under a Periodic Tenancy Agreement?
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  • Has the tenant given you or your managing agent notice of intention to vacate?*
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  • Have notices to vacate been issued to the tenant?*
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  • Has a claim been lodged with the Tribunal?*
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  • What date did the tenant move into the premises?*
     - -
    2 digit day, 2 digit month, 4 digit year
  • What date did the tenant vacate/or return the keys?
     - -
    2 digit day, 2 digit month, 4 digit year
  • What date did the tenant pay their rent up to?
     - -
    2 digit day, 2 digit month, 4 digit year
  • Has the Bond been claimed?*
  • Have the premises been re-let?*
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  • Type of Claim(s) Required

  • What type of claim(s) will you be submitting?*

  • Property and Contents Claim

    Note: You must report any loss, theft or vandalism to the police. We may need to apply for a copy of your report.
  • Did the loss occur at the insured address?*
  • Date of loss*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Is a third party responsible for the loss/damage (including a tenant)?
  • Were the police notified?*
  • Report date
     - -
    2 digit day, 2 digit month, 4 digit year
  • Are you claiming for:*
  • Details of property damage
  • List of items lost, damaged or stolen
  • Do you own the listed items?
  • Are there any other interested parties?*

  • Additional information required:

    1. If the damaged item is repairable, please attach quote(s) for repair.
    2. If the damaged item is unrepairable, attach the original receipt, valuation, quotes for replacement or certification from an authorised repairer that the item is unrepairable.
    3. Photographs of the damaged property should also be supplied to us if available.
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  • Rent Default Claim

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  • Cleaning and re-letting expenses should be deducted from the bond as follows:
    Rows

  • Payment Details

  • Do you want payment to be made by electronic funds transfer?*

  • Disclosures

  • Claim Privacy Statement  

    By continuing, you confirm that you understand and consent to all information disclosed on this claim form to be shared with Risksmart Claims Solutions Pty Ltd (Risksmart, we, us, our).

    We collect, use, disclose and handle personal information in accordance with the Australian Privacy Principles under the Privacy Act 1988 (Cth). You can access a copy of our Privacy Policy on our website at http://risksmartclaims.com.au/privacy-policy/.

    Your personal information will be used by Risksmart for the purpose of managing your insurance claim. We provide information we collect about any claims you make to your insurer (or anyone your insurer has appointed to assist it to consider your claim, e.g. loss adjusters, medical brokers, solicitors etc) to enable it to consider your claims. Insurers may in turn pass on this information to their reinsurers. Risksmart may also disclose your personal information to witnesses in respect to your claim and to government agencies including the police (where we are compelled by law).

    If you do not wish for your personal or sensitive information to be passed onto any of the above listed recipients, please contact us on 02 8297 1722. We note that in the event that you decide not to provide Risksmart with the required information, or you do not consent to the terms of the Privacy Policy or revoke your consent, we may not be able to assess your claim.

    If you have any queries about Risksmart’s Privacy Policy, please contact our Privacy Officer at privacyofficer@honan.com.au. 

     

    Privacy Consent, Declaration and Authority 

    I: 

    • consent to the collection, use and disclosure of my personal information in accordance with Risksmart’s Privacy Policy and this document for the lodgement of my claim. This consent remains valid unless I alter or revoke it by giving written notice to Honan; 
    • confirm that any information that I supply will be true and correct and that I will not withhold any information likely to affect the assessment of my claim by the insurer; 
    • Authorise Risksmart to disclose my personal information to the insurer and other third parties referred to above where relevant to the lodgement or assessment of my claim. 

  • Declaration

  • (lf a firm / company, the following declaration must be made and signed by a member of the firm, so describing him self / herself)

    I/We declare that the above answers are true and correct to the best of my/our knowledge and that I/we have not withheld any relevant information that may affect the claim. I/we consent to Risksmart Claims Solutions Pty Ltd using my personal information provided on this form for the purpose of processing my claim.

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