Make a Claim
Loss Notification Form
Policy Information
The fastest way to lodge a claim is to access our online broker portals, loss notifications should be lodged on Pulse for Broadacre and Cotton policies and PATH for Horticulture policies this season. If the loss relates to a previous season, or a product that is no longer available, please complete the details below or download and complete our Loss Notification Form and email it to us.
Product
*
Broadacre
Cotton
Policy Number
*
Insured Name
*
Property Name
*
Shire
*
Contact Name
*
Phone Number
*
Mobile Number
*
Cause of Loss
*
Date of Loss
*
DD slash MM slash YYYY
Time of Loss
*
:
Hours
Minutes
AM
PM
AM/PM
QUESTIONNAIRE
Please indicate the level of damage (estimated %) to all insured Blocks/Fields.
*
Block / Field Number
Block / Field Hectares
Hectares Damaged
Level of Damage
Remarks
Please provide any further information
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.
