BMIA Broker Network - Notification of a Claim

Notification of a Claim

Policy Holder Details

Policy Holder Name

Invalid Input

Are you GST registered?(*)

Yes

Invalid Input

Policy Number

Invalid Input

What percentage of your premium do you claim GST on?

Invalid Input

Contact Information

Your Name(*)

Please let us know your name.

Contact Number(*)

Invalid Input

Relationship to Insured(*)

Email Address(*)

Invalid Input

Claim Details

Loss / Incident Location

Invalid Input

Date of Loss or Incident

Invalid Input

Description of Loss/Incident

Invalid Input

Upload supporting documents (e.g Photos of demages, repair invoices/quotes, wiitness statements)

Invalid Input