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Date: ________
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RE: TRAVEL INSURANCE CLAIM – POLICY NO. ________
Dear Sir or Madam,
I write to lodge a claim under the above travel insurance policy issued by you (the Policy). This letter constitutes notice of a claim for the purposes of the Policy and is made in accordance with my rights under that contract of insurance, the Insurance Contracts Act 1984 (Cth) and the General Insurance Code of Practice.
1. Claim particulars
Policyholder / Insured: ________
Policy Number: ________
Date Policy commenced: ________
Period of travel insured: ________
Date of Incident: ________
Place of Incident: ________
Description of Incident:
________
Item(s) and loss(es) being claimed:
________
Total amount of claim:
$________ (________)
2. Duty of utmost good faith and disclosure
I confirm that the information set out in this letter and in the enclosed documentation is true and correct to the best of my knowledge and belief, and that I have complied with my duty to act towards you with the utmost good faith as required by section 13 of the Insurance Contracts Act 1984 (Cth). I am not aware of any other insurance policy under which this loss may be claimed, save as follows: ________.
3. Supporting documentation
In support of this claim I enclose the following documentation:
(a) a completed claim form;
(b) a copy of the relevant police or incident report (reference: ________);
(c) receipts, invoices and other evidence of the expenses and losses incurred;
(d) a copy of my travel itinerary and proof of travel;
(e) the following additional enclosures:
________
4. Payment requested
________
5. Further information and complaints
I look forward to your response and to the prompt resolution of this matter. Thank you for your attention.
Yours faithfully,
________
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