• General details
  • Claim details
  • Declaration
Please complete the details below.
Claim Type
Please select the type of claim*
Insured details
Name of insured*
Policy number*
Contact person*
Postal address
Suburb
State
Phone number*
Email address
Are you registered for GST?*
What is your ABN*
Are you entitled to claim an input tax credit for repair or replacement of the items that have been lost or damaged?*
Are you claiming less than 100%?*
Please specify percentage*
%

Should a survey be required, our appointed surveyor will contact the person shown above, unless you advise an alternative contact.

Settlement details
Direct debit settlement payment

Where applicable AM&T will settle directly into your bank account once the liability for this claim is agreed.
Please provide your banking details.

Account name
Bank
BSB
Account number
Cheque settlement payment