Liability Claims Notification | WFI

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To notify our Liability Claims Team of a liability claim made against you, or an incident which may result in a claim against you, please complete the below form and we will contact you as soon as we can.

Liability claims can include verbal or written demands for compensation by a third party person or company for personal injury or property damage allegedly caused by you, your home or your farm business.

* Required

About You

Surname *

First Name *

Address *

Postcode *

Preferred Contact Number

Email Address *

About your policy

Name of Insured

Policy Number

Are you registered for GST purposes? *

ABN number Enter your ABN using the following format: XX XXX XXX XXX

Have you claimed or are you entitled to claim an input tax credit on the GST applicable to this policy? *

Yes

No

Not sure

Specify the amount claimed or entitled to be claimed. Enter the amount as percentage 1-100 (%)

About the claim

Date of incident *

Date you first became aware of the incident *

Location of incident

Description of alleged injury or property damage *

Claimant’s full name

Claimant’s phone number

Claimant’s email address

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