Need help resolving a customer complaint/feedback.
Receive notice of a claim against you, a staff member or
Would like to discuss a claim already in progress.
Need to lodge a new claim.
Your policy number.
Details and dates of inspections, treatments and alleged actions that give rise to the potential claim.
Name and address of your customer (the claimant).
Details of their allegations.
Please complete this form with as much detail as possible. Upon completion, a Claims Officer will be in contact to discuss the issue. This form must be completed by a Partner/Director/Principal of the Insured. All questions must be answered as fully as possible.
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