musical instruments claim form - ebm instruments/muآ musical instruments claim form post to:...
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Elkington Bishop Molineaux Insurance Brokers Pty Ltd | ABN 31 009 179 640 | AFSLN 246986 | Est 1975 Musical Instruments Claim Form | Page 1 of 2
Please complete the form and choose either EMAIL THIS FORM to email the form or PRINT THIS FORM to print then fax or post
MUSICAL INSTRUMENTS CLAIM FORM Post to: Musical Instruments Division Fax: 1300 365 822 EBM PO Box 10841, Southport BC Qld 4215
IT IS A CONDITION OF YOUR POLICY THAT WRITTEN DETAILS OF THE CLAIM ARE RECEIVED BY INSURERS WITHIN 30 DAYS. PLEASE RETURN YOUR CLAIM FORM AS SOON AS POSSIBLE.
1.0 Contact Details
The issue of this Form is not an admission of liability and is issued without prejudice.
BEFORE ANY QUESTIONS ARE ANSWERED, PLEASE READ CAREFULLY THE DECLARATION AT THE END OF THIS FORM WHICH YOU ARE REQUIRED TO SIGN.
2.0 Claim Information
Are you the Owner of the property insured?
Describe how the loss/damage occured?
Description of Property lost or damaged:
Elkington Bishop Molineaux Insurance Brokers Pty Ltd | ABN 31 009 179 640 | AFSLN 246986 | Est 1975 Musical Instruments Claim Form | Page 2 of 2
CLEAR FORM to start over PRINT this form to Post or FaxEMAIL to EBM SAVE
If any other action has been taken to recover the property, please give details:
Name of Repairer:
Address of Repairer:
PAYMENT OF YOUR CLAIM (Please tick which method you would prefer):
To your repairer directly (Details above) To your Bank Account directly
Bank & Branch:
Have the Police been notified? No
If Yes, please complete the below information;
BSB Number: Account Number: Swift Code:
I hereby declare that the details given on this form are complete and true to the best of my knowledge.
IF THEFT, MALICIOUS DAMAGE OR LOSS IS INVOLVED, THE POLICE MUST BE NOTIFIED
Date of Loss/Damage: Time of Loss/Damage:
2.0 Claim Information (Continued)
Date of Notification:
If damaged, what is the estimated cost of the repair? (Please attach a quote)
PLEASE NOTE: No repairs are to be undertaken without express approval from EBM.
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Please return to EBM with copy of the quote for repairs, your valuation and photos of damage.
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