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Public or Products Liability Claim Form

If you have a letter of demand from a third party or verbal correspondence of a similar nature please contact our office immediately on (08) 9433 3400.

To make a report of a possible claim:

  • Download the claim form and complete it
  • Fax all information to our office on (08) 9433 3411

*The claim form can be opened in Adobe Acrobat Reader (Click here to download and install this free program if it's not already on your system) You can complete the form in that application using the editable fields provided prior to printing it out if preferred. Type Xs into the check boxes as required. Only your signature and the date need to be completed in pen after printing out the form.

Liability Claim Form Liability Claim Form (330 KB)

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