Professional indemnity claim form

If you wish to report an incident with regards to your professional indemnity insurance  please fill out the incident report form below.

Section 1 - Policy information


Will you be the main contact for this claim?*

Are you the Insured Policyholder?*

Do you give authorisation for anyone else to act on your behalf for this claim?*

Section 2 - Event details


Section 3 - Injury information

Was anybody injured?*

Section 4 - Property damage information

Was any property damaged?*

Section 5 - Further details


Please upload any relevant documents

This field is required

Add another

Section 6 - Information regarding GST


Are you registered for GST?

Have you claimed an input tax credit for the GST included in your insurance policy premium?

If yes, was the amount of GST claimed less than 100% of the GST included in the premium?