onlineclaimsubmission

Online Claim Submission

Required Fields are in Red

Claimant's Details

Claimant's Name:

Address:

Work Ph:

Home Ph:

Other Phone:

* Note: A claimant contact number is usually required in order to validate the scope of all claims. Please provide one where possible.

Your Claim Contact Details

Assessing Company

First Name:

Last Name:

Your Email:

Order/Ref No: (must be unique)

Job Request Type:

Faxing Additional Information?

Yes No

Insurer Claim Details

Insurer Company Name:

Insurer Claim Manager:

Claim Number: (must be unique)

Policy No:

Date of Loss:

Was proof provided by claimant?

Yes No

Details of equipment and any other relevant information:

WARNING: Please submit a claim once only for any one claim number. If you have made errors and wish to correct them, please send an email to ron@abbeytech.com.au