Hollard Insurance - Home Event Claim Form - Hollard Claims Administration

Duty

When answering any questions or completing your claims details you need to be honest, accurate and truthful in your answer. We may reduce or refuse to pay your claim or cancel the policy if you have failed in this duty.

You confirm that you understand your Duties. Additionally, you confirm that you have read our Privacy Policy. You further understand that any advice provided to you on this website is general only and does not take into account your individual circumstances.

Do you understand your duty?*

* Mandatory Fields

YesNo

1. Policy holder information

Policy holder name

What is your policy number?*

Are you a Business or an Individual?*

BusinessIndividual

Business Name (optional)

First name*

Surname*

Policy holder address

Street Number

Street Name

Street Type

Suburb*

Postcode*

State / Territory

Your Contact Details

Are you the policy holder?*

Yes No

First name*

Surname*

Mobile

Home Phone

Work Phone

Email*

Your preferred method of contact*

MobilePhoneEmail

Best time of day to contact you

AMPM

Nominate a representative to speak on your behalf

Event Claim Notification

Duty

Policy holder name

Policy holder address

Your Contact Details

Event Information

Event details

Damaged Items

Reported to Police or the Fire Brigade