Claim Submission Form

Please fill in this form to the best of your ability and make sure to complete all relevant fields. If you are unsure or don’t have enough information, please skip or type in N/A.

Permitted files JPG, PDF, PNG can not be larger then 10MBs per file

A) Details of Membership

B) Details of Event

MM slash DD slash YYYY

C) Claims for loss by BURGLARY, THEFT or MALICIOUS DAMAGE

D) Cost of Damages

Please complete for all items being claimed for, attaching additional sheets as necessary


Loss of Property

Damage of Property

Max. file size: 25 MB.
Max. file size: 25 MB.
Max. file size: 25 MB.
Max. file size: 25 MB.
Max. file size: 25 MB.

Please Note:

(1) Tax Invoices for repairs or replacement must be submitted.

(2) Where an item of equipment must be replaced, and you propose to replace that item with:

  • :- The same brand of equipment, but a different model; or
  • :- The same brand of equipment, but a different model; or

You must indicate whether the replacement equipment is the equivalent of, or better or more extensive than, the equipment it is replacing.

Max. file size: 25 MB.
Max. file size: 25 MB.
Max. file size: 25 MB.
Max. file size: 25 MB.

E) Declaration

Untitled*
Permitted files JPG, PDF, PNG can not be larger then 10MBs per file