• Skip to main content
salon-insurance-logo

1300 373 586

  • Services
  • Packages
  • Claims
  • Contact

Claims

"*" indicates required fields

1Policy Details
2General Details of Loss / Damage
3Other Particulars
4Declaration
5Schedule
6Third party claims

Policy Details

Full Name(s) of Insured:*
Address of Insured:*
DD slash MM slash YYYY

General Details of Loss / Damage

DD slash MM slash YYYY
Approximate time of loss / damage
:
Is any Third Party to blame for loss or damage?*
Have you received, or do you anticipate receiving, notice of any claim from or on behalf of Third Parties?*
Give details of all witnesses, if any:
Name
Address
Postcode
 
Were the Police notified?*
DD slash MM slash YYYY
Have you taken any action to recover or reduce your loss?*

Other Particulars

Are you a registered business?*
Please provide bank account details, should you wish for claim settlement to be paid into your account;

Declaration

I/We, the undersigned claimant(s) hereby declare that the foregoing statements and particulars of the claim are true and correct and that I/We have not withheld any information relevant to this claim.

I expressly agree that the information given by me is provided with my full knowledge and consent and further agree to hold harmless and indemnify Direct Insurance Brokers Pty Ltd in the event of any action or matter that may be taken by any party pursuant to the Privacy Act 1988 (Cth).

Schedule

Please complete for Loss of property
Description of property for which loss is claimed
Date of Purchase or Acquisition
Original Cost
Value at time of Lossallowing for reasonable Depreciation
Value of Salvage (if any)
Amount of Loss or Damage Claimed ($)
 
Please complete for Damage to property
Particular
Name of Repairer (Invoice / Quote)
Cost of Repairs ($)
 
Please complete for Fusion damage
Machine / Appliance
Maker
Date of Purchase
H.P. of Motor
Name of Repairer Invoice/Quote Attached
Cost of Repairs ($)
 
(Note: To Avoid delay, attach invoice giving the separate items of costs as certain items may not be claimable)
Drop files here or
Max. file size: 8 MB.

    Third party claims

    Name*
    Address*
    (eg. relative, employee)
    Have you received any correspondence from third parties?*
    Have you made any admission of liability?*
    This field is for validation purposes and should be left unchanged.
    • FSG
    • Privacy Policy
    • Your Disclosure Obligations
    • Insurance Broker Code of Practice
    • Terms of Engagement

    ABN 39 010 352 075 | AFSL 241075

    Copyright © 2025· Salon Insurance Australia is a registered business name of Direct Insurance Brokers Pty Ltd | Website by