Electrical Damage

Electrical damage is also known as fusion or motor burnout. Electrical damage is the fusion or burning out of the actual wiring of a domestic motor by an electrical current.

The policy excludes consumable items such Lighting or heating elements, fuses or protective devices.

If electrical damage has occurred on your property, please complete the form below. To assist with the process, please submit a report from your licenced electrician and provide us with as much information about the incident as possible, including itemised quotes for repair/replacement of the motor.

Electrical Damage Claim Form

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PRIVACY NOTICE

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We are committed to ensuring that all Our Business dealings comply with the APPs and acknowledge the importance of keeping personal details for individuals confidential and secure.

We collect personal information for the purpose of providing insurance, including arranging insurance, policy administration and claims handling. Without this information, we are not able to provide you with the services You require.

If you would like a copy of our privacy policy, would like to seek access to or correct your personal information, or opt out of receiving materials We send, please contact us.

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CLAIM SUBMITTED BY

This form was completed by
Name of person submitting the form
 
Email
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SECTION A - OWNER/S

Policy Number
Expiry Date
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Insured Details

Insured Name
Insured Email
Contact Number
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Payment Instructions

Payment option
 
Bank
Account Name
BSB
Account Number
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Address of Premises where Loss or Damage occurred

Full Address
House/Street Number
Suburb,State,Postcode
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Claim Details

This Policy Does Not Cover:
  1. Loss of use, depreciation, wear and tear.
  2. Electrical contacts at which sparking or arcing occurs in ordinary working.
  3. Lighting or heating elements, fuses or protective devices.
  4. Any amount recoverable under a manufacturer’s or retailer’s guarantee or warranty.
Date of Incident
Time of Incident
Provide exact details how the loss / damage occurred?
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Appliance Details

Make
Size or HP
Type and function
Year of manufacture
Date of last repair / service
Amount Claimed
Is it under warranty?
 
(If Yes) Provide warranty details
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LICENSED ELECTRICIAN REPORT
EMAIL FORM OR UPLOAD REPORT

Licensed Electrician Email

Licensed Electrician Report (Download PDF Form)
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CLAIM ATTACHMENTS

Please ensure the following for file upload:
  • The file size cannot exceed 25 megabytes.
  • Upload of files can take between 5 to 10 minutes depending on the file size and your internet speed.
Repair Quote
Replacement Invoice
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Input Tax Credit entitlement

Is ITC applicable?
 
What is your ABN?
Input Tax Credit entitlement percentage for GST on premium
If you are a business and do not provide us with your ABN, we may withhold tax on payments we make under your claim.
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Insured Declaration

I declare that:
  • All statements and particulars stated on this form and all documents submitted are true and correct.
  • I will give all reasonable assistance and co-operation to the insurers in the assessment of my claim.
  • I have not withheld any material information connected with this claim that will inhibit the insurer’s ability to make a fair and reasonable assessment of my claim.
  • I understand that this claim may be refused if any information provided is false, or inaccurate or concealed.
  • I acknowledge that my personal information may be disclosed to, and obtained from related entities, other insurers, investigators or other parties providing services to the Insurer.
  • I assign to the insurer all rights of recovery/salvage against any person or organisation and will cooperate to secure such rights.

Claim Confirmation Message

Thank you. Your claim has been received and will be processed by our staff within 2 working days. A copy of the claim form has been sent to your nominated email address. If you do not receive it within 24 hours, please contact us.

Claim Saved For Later

Thank you. Your Electrical Damage Claim claim has been saved and an email was sent to . To complete the claim please follow instructions in the email.

Do you want to continue entering claim?

No
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