Repair/Insurance Claim Request

General Claim Form (The issue of this form is not an admission of liability) Incorporating Service/Repair Request.

Enquires can be directed to:
- Rent-Tech Pty Ltd on 1300 781 448

Details *required information  
Contract No.:
*Lessee/User name
*Address
*Suburb
*Postcode
*Make
*Model
*Serial Number
*Briefly describe nature of the problem and what you were doing at the time.
Service Agent Assesment* Repair under warranty
Insurance Declaration Insurance Claim
Were there any other insurances in force covering the property at the time of loss?
If so, give particulars and name of insurance company:
Policy #
*Date of Event:
Time:
*Address where event occurred:
*Suburb
*Postcode
Amount of Claim Please fax a copy of the quote to Rent-Tech on 08 9344 8348
If Burglary/Malicious Damage/Fidelity, has it been reported to the Police?
Is any other party to blame for loss or damage? If Yes, Who?
In your own opinion, why?
DECLARATION
If a firm, this declaration must be made and signed by a member of the firm, so describing himself) I/WE do hereby declare that foregoing answers are true and correct, that I/WE have in no manner caused the said loss or by any fraud or wilful misrepresentation sought unjustly to benefit by the said event and that the information detailed in the Schedule appearing on the back hereof is a true and faithful account of the actual loss sustained. AND I/WE hereby undertake and agree to notify Rent-Tech PTY LTD immediately if any of the lost or stolen property mentioned in this claim is subsequently recovered, and at the option of the Rent-Tech PTY LTD to return the property or to refund the amount of money received by way of compensation in respect thereof.
 
 
 

QUICK REFERENCE

Rent-Tech help (finance, risk cover & servicing)

1300 781 448

business hours