Incident Report Form
Please complete and submit the following form in the event an incident has happened that may lead to a claim under your
This form is suitable for use for Material Damage claims such as Fire, Storm, Rainwater, Fusion, Burglary, Theft and Liability for Personal Injury and/or Property Damage.
IMPORTANT:Do not use for Workers Compensation, Professional Indemnity or Motor Vehicle Incidences.
Submission of this form will allow us to commence a Claim file and advise your Insurer. Certain questions prompt you for the submission of additional documentaion and we suggest these can be emailed or faxed to our office if available.
Note: As this incident report may be subject to FREEDOM OF INFORMATION (FOI) and/or DISCOVERY for litigation purposes, please ensure that only factual information is included in this form. Location Map and Contact Information