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General Letter to Claim from Insurance - Template Form Pro · AU-law

✓ Valid in Australia · drafted to comply with local law

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General Letter to Claim from Insurance - Template Form
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________
________
________
________

Date: ________

________
________

Attention: ________


RE: NOTIFICATION AND LODGEMENT OF INSURANCE CLAIM — Policy No. ________


Dear Sir or Madam,

I, ________, being the policyholder under the above-referenced policy of insurance issued by your company, write to formally notify you of, and to lodge, a claim under that policy in accordance with my rights and your obligations under the Insurance Contracts Act 1984 (Cth) and the relevant provisions of the General Insurance Code of Practice.

§ 1. The Insuring Party and Policy

1.1 Policyholder / Insured: ________

1.2 Policy Number: ________

1.3 Type of Cover: ________

1.4 Period of Insurance: ________

§ 2. Particulars of the Incident

2.1 On ________, at approximately ________, the following incident occurred at ________:

________

§ 3. Particulars of the Claim

3.1 Item(s) and/or loss being claimed:

________

3.2 Total amount of claim: AUD $________

§ 4. Supporting Documentation

4.1 I enclose the following documents in support of this claim:

(a) a completed and signed claim form;

(b) a copy of the police report (Reference No. ________), where applicable;

(c) proof of purchase and/or ownership documents in respect of the item(s) claimed;

(d) the following additional enclosures:

________

§ 5. Request for Payment

5.1 In reliance on the policy and the documentation provided, I respectfully request that the amount specified in clause 3.2 be assessed and paid to me at your earliest convenience, and in any event within the timeframes prescribed by the General Insurance Code of Practice.

5.2 Payment is requested by the following method:

________

5.3 Account details for payment (where applicable):

Account Name: ________
BSB: ________
Account Number: ________

§ 6. Reservation of Rights

6.2 I expressly reserve all rights available to me at law and in equity, including under the Insurance Contracts Act 1984 (Cth) and the Australian Securities and Investments Commission Act 2001 (Cth).

Should you require any further information or additional documentation in order to process this claim, please do not hesitate to contact me using the details provided above. I look forward to your prompt response and to the timely resolution of this matter. Thank you for your attention to this claim.


Yours faithfully,




________
Signature: ________
Date: ________

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