This document is an insurance claim form from QBE Insurance (Australia) Limited. It requests information about the policyholder, property, incident details, previous claims history, and a declaration authorizing QBE to obtain relevant information to process the claim. The form has sections for compulsory information, as well as optional sections depending on the type of claim, such as breakage of glass, storm damage, theft/burglary, and details of the claimed loss or damage. The policyholder must provide complete information for QBE to process the property damage or loss claim.
1) The claimant is seeking compensation for property that was damaged, lost, or stolen according to their property insurance policy with Allianz.
2) Key details are provided about the claimant, the insured property and items, and the incident where the loss or damage occurred.
3) The claimant is asked to provide additional information such as whether the police were notified, what security measures were in place, and if there are any other parties responsible. Witnesses to the incident are also requested to be identified.
This 3 sentence summary provides the high level information from the Arizona property tax refund claim document:
The document is an Arizona property tax refund claim form for tax year 2000, where the claimant provides their personal information and answers questions to determine if they qualify for the refund based on being an Arizona resident, age, income level, and whether they paid property taxes or rent. The claimant is instructed to provide the total household income and their property taxes paid, and the form calculates the potential refund amount.
The document is a property claim report form for reporting lost, stolen, or damaged property to an insurance company. It requests information to process a claim, including: the policy details, contact information, description of the incident, property details, previous claims history, and a declaration authorizing the insurer to process the claim. It informs the claimant to retain damaged items if possible and attach estimates, receipts or other documentation to support the value of items being claimed.
This document is a general claim form for Wesfarmers General Insurance. It contains instructions for completing the form when property is lost, damaged, stolen or destroyed. It notes that temporary repairs may be necessary to protect the property. The form requests details about the insured, policy, incident details, property and repairs. It also contains information on privacy, complaints procedures and declarations.
The document is an engineering/fusion claim form for an insured named John Doe. It requests information about the incident, damaged equipment, repairs, costs, and other relevant details to process an insurance claim. The insured is claiming damage to a refrigerator that needs repairs costing a total of $1,500 according to the attached repair quote.
This document is an Arizona property tax refund claim form for tax year 2001. It allows taxpayers to claim a refund for property taxes paid or rent paid in lieu of property taxes. The form collects information about the claimant's residency, income, property taxes or rent paid, and requests a signature to verify the accuracy of the information provided. It provides instructions for calculating the refund amount and includes schedules to determine the credit based on living situation and household income.
Citi mortgage financial_application - blankjanicekoss
This document is a hardship assistance package from CitiMortgage requesting financial and property information from a borrower. It requests documentation like pay stubs, tax returns, and bank statements. It collects information on the borrower's intentions for the property, income, expenses, and reason for being behind on mortgage payments. The borrower must authorize CitiMortgage to obtain additional information and verify the accuracy of the provided details.
This document provides forms and instructions for a hardship assistance package to help borrowers who are behind on their mortgage payments or in danger of default. It requests copies of recent pay stubs, tax returns, and bank statements. It includes forms to provide borrower information, property details, income and expense details, assets, general hardship questions, and an authorization to release information. Borrowers are instructed to complete as many questions as possible and that additional information may be needed to thoroughly review the situation.
1) The claimant is seeking compensation for property that was damaged, lost, or stolen according to their property insurance policy with Allianz.
2) Key details are provided about the claimant, the insured property and items, and the incident where the loss or damage occurred.
3) The claimant is asked to provide additional information such as whether the police were notified, what security measures were in place, and if there are any other parties responsible. Witnesses to the incident are also requested to be identified.
This 3 sentence summary provides the high level information from the Arizona property tax refund claim document:
The document is an Arizona property tax refund claim form for tax year 2000, where the claimant provides their personal information and answers questions to determine if they qualify for the refund based on being an Arizona resident, age, income level, and whether they paid property taxes or rent. The claimant is instructed to provide the total household income and their property taxes paid, and the form calculates the potential refund amount.
The document is a property claim report form for reporting lost, stolen, or damaged property to an insurance company. It requests information to process a claim, including: the policy details, contact information, description of the incident, property details, previous claims history, and a declaration authorizing the insurer to process the claim. It informs the claimant to retain damaged items if possible and attach estimates, receipts or other documentation to support the value of items being claimed.
This document is a general claim form for Wesfarmers General Insurance. It contains instructions for completing the form when property is lost, damaged, stolen or destroyed. It notes that temporary repairs may be necessary to protect the property. The form requests details about the insured, policy, incident details, property and repairs. It also contains information on privacy, complaints procedures and declarations.
The document is an engineering/fusion claim form for an insured named John Doe. It requests information about the incident, damaged equipment, repairs, costs, and other relevant details to process an insurance claim. The insured is claiming damage to a refrigerator that needs repairs costing a total of $1,500 according to the attached repair quote.
This document is an Arizona property tax refund claim form for tax year 2001. It allows taxpayers to claim a refund for property taxes paid or rent paid in lieu of property taxes. The form collects information about the claimant's residency, income, property taxes or rent paid, and requests a signature to verify the accuracy of the information provided. It provides instructions for calculating the refund amount and includes schedules to determine the credit based on living situation and household income.
Citi mortgage financial_application - blankjanicekoss
This document is a hardship assistance package from CitiMortgage requesting financial and property information from a borrower. It requests documentation like pay stubs, tax returns, and bank statements. It collects information on the borrower's intentions for the property, income, expenses, and reason for being behind on mortgage payments. The borrower must authorize CitiMortgage to obtain additional information and verify the accuracy of the provided details.
This document provides forms and instructions for a hardship assistance package to help borrowers who are behind on their mortgage payments or in danger of default. It requests copies of recent pay stubs, tax returns, and bank statements. It includes forms to provide borrower information, property details, income and expense details, assets, general hardship questions, and an authorization to release information. Borrowers are instructed to complete as many questions as possible and that additional information may be needed to thoroughly review the situation.
This document is a product disclosure statement and policy wording for First Option Business Insurance. It contains important information about the General Insurance Code of Practice, underinsurance/average clauses, duty of disclosure requirements, privacy policy, and details to be provided in the application form such as business/premises details, interests of other parties, and security measures in place.
This document is a rent certificate used to verify rent paid in Wisconsin. It provides instructions for renters and landlords to fill out the form. Renters provide identifying information and rental details. Landlords provide contact information and sign to verify the rental details. Rent amounts, number of occupants, and value of services provided are reported to calculate allowable rent for homestead tax credit claims.
This document contains a property claim form for Calliden insurance. It requests information to process a claim for loss or damage to insured property. The three-page form requests details of the policy, loss event, repair costs, previous claims history, and a declaration authorizing Calliden to process the claim. It also contains brief sections on Calliden's privacy policy and disputes resolution process.
This document is an Arizona state tax form for claiming a property tax refund or credit for the year 2005. It provides instructions for qualifying for the credit and calculating the amount. The form requests personal information and details of household income, property taxes paid, and dependents. It then uses schedules to determine the amount of the tax credit based on household income and living situation. The credit can be direct deposited or paid as a refund.
This document is an Indiana state tax return form for 2008. It provides instructions for filing as an individual taxpayer and includes sections to report income, deductions, exemptions, taxes owed or refund amount. Key details include reporting federal adjusted gross income, Indiana deductions, exemptions, state and county tax amounts, credits, payments made including withholdings, and amounts owed or to be refunded.
This document appears to be a claim form for machinery or computer equipment. It requests information such as contact details, policy details, purchase details of the damaged item, and details of the claimed loss or damage. The claimant is asked to provide payment details and attach relevant documents like invoices. If claiming for refrigerated goods, the form requests a list of damaged goods with costs. A repairer section asks for technical details of the damaged item and repairs.
This document is an insurance claim form from QBE Insurance (Australia) Limited for a machinery claim. It requests information about the insured, the incident details, the item in question, repair details, invoices and a declaration authorizing QBE to obtain information. The form must be fully completed and original invoices submitted for the claim to be processed.
This document is a Maine Form 1040X, which is used to file an amended individual income tax return. It provides instructions for taxpayers to correct their original Maine tax return. The form includes sections to report income, deductions, exemptions, payments and the refund or amount owed. Taxpayers must explain any changes on page 2 and attach supporting documents. The instructions provide guidance on filing amended returns, reporting income and deductions, and claiming refunds for deceased taxpayers.
This document is a rent certificate used to verify rent paid in Wisconsin for homestead credit purposes. It provides instructions for both renters and landlords to complete. Renters fill out basic information and give it to their landlord to verify rent details for the year. If landlords do not sign, renters can provide proof of rent paid instead. It also provides an explanation of how to calculate allowable rent amounts and includes a supplemental schedule for shared living expenses.
The document outlines insurance requirements for renting equipment from Ahern Rentals, including:
1) The customer must provide a certificate of insurance naming Ahern Rentals as an additional insured and loss payee and listing their address.
2) The certificate must show minimum liability and property damage insurance limits.
3) Ahern Rentals requires 10 days notice of cancellation of the customer's insurance policy.
This document outlines a Trades Package Insurance Policy from QBE Australia that provides business insurance covering property, general liability, tax audit, transit, statutory liability, employment practices and other areas. It details what is and isn't covered, how to make a claim, exclusions, conditions, and other important policy information. QBE is a major Australian insurer seeking to provide strong financial protection and industry-leading insurance solutions to intermediaries and their clients.
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Dokumen ini membahas pengobatan kencing manis menurut pengobatan tradisional Tiongkok. Kencing manis dibagi menjadi 3 jenis berdasarkan organ yang terpengaruh, yaitu Siao Atas (paru-paru dan jantung), Siao Tengah (limpa dan lambung), dan Siao Bawah (ginjal). Setiap jenis memiliki gejala khas dan titik akupresur yang digunakan untuk mengobatinya, seperti BL22, TE5, BL13, LU
This document is a commercial/retail/industrial insurance policy underwritten by QBE Insurance Australia Limited. It contains general information about the policy, details of the policy terms and conditions, and outlines the various cover sections included in the policy such as business property, business interruption, theft, money, machinery, public and products liability, glass and others. The policy is a legal contract between the insured and the insurer and must be read in full to understand the details of coverage provided.
This document outlines the terms and conditions of a general and products liability insurance policy. It includes definitions of key terms, descriptions of what is and is not covered, and procedures for claims and cancellations. Key exclusions include property owned by the insured, damage to products, faulty workmanship, asbestos, breach of professional duty, contractual liability, employers' liability, and fines, penalties or punitive damages.
This document summarizes the development of the author's Twitter account over its first month. It shows screenshots of her account with increasing numbers of followers and accounts followed over January and February 2013. The author explains how following educational organizations and colleagues has helped her connect to resources and people in the teaching field and learn more about the Alberta education system. She reflects that Twitter will help her collaborate, connect, and communicate with different people throughout her career in education.
1. This policy provides office insurance covering property, business interruption, money, glass, liability, employee dishonesty, machinery, computer equipment and other sections.
2. Key details include the insurer as CGU Insurance Limited, the policy number and period of insurance shown on the schedule.
3. The policy is subject to general definitions, conditions, exclusions and claims procedures outlined in the document. Each section also contains specific coverages, limitations, definitions and procedures.
This document provides a summary of a business insurance policy. The policy consists of multiple cover sections that can provide insurance for business property, business interruption, theft, money, machinery, public and products liability, glass, general property, employee dishonesty, goods in transit, tax probe, legal expenses, commercial motor vehicles, and other risks. The document outlines the key details, conditions, exclusions, and claims process for the policy. It is intended to help the business owner understand what risks are covered and the process for making claims.
This document summarizes a general and products liability insurance policy from Steadfast General and Products Liability Insurance. Some key points:
- It provides definitions for important terms used in the policy like "advertising injury", "aircraft", "business", and "electronic data".
- The insuring clauses describe what is covered, including legal liability for personal injury, property damage, and advertising injury from the insured's business activities. It also covers defense costs and supplementary payments.
- Exclusions are listed for what is not covered, such as aircraft, asbestos, contractual liability, faulty workmanship, pollution, and terrorism.
- The claims conditions specify requirements around notification of claims to the insurer
This document is a business claim form from QBE Insurance (Australia) Limited. It requests information about the insured, property, premises, and incident details. It asks the claimant to provide their contact information, property ownership details, description of the loss/damage, previous claims history, and security/police report information. The form is comprised of three compulsory parts: Part A requests insured details, Part B is for relevant sections depending on the claim type, and Part C requires signature and declaration.
QBE Insurance (Australia) Limited received a liability claim from an insured. The document provides instructions for submitting a claim and requests details about the incident, those involved, any injuries, property damage, witnesses, and whether police were contacted. It also notes that submitting a claim does not constitute an admission of liability and requests that the insured not admit fault. Personal information is collected in accordance with QBE's privacy policy.
The document provides a Product Disclosure Statement and Policy Wording for Vero Business Insurance. It consists of 4 parts:
1. A policy summary that outlines the different cover sections available and what they cover in 3 sentences or less.
2. Important information about the policy including cooling off periods, duty of disclosure, privacy, and making complaints.
3. Additional information for individuals or small businesses insuring vehicles or home buildings.
4. The full policy terms and conditions for each cover section, general exclusions, conditions, and definitions. It provides the details of what is and isn't covered for each section of the policy.
This document is a glass claim form for Wesfarmers General Insurance. It contains instructions for completing the form when insured plate glass is damaged. The form requests details about the policy, contact information, description of the damaged glass, and a declaration. It notes that original invoices or estimates should be attached, and that the claim will be assessed according to the policy details provided.
This document is a product disclosure statement and policy wording for First Option Business Insurance. It contains important information about the General Insurance Code of Practice, underinsurance/average clauses, duty of disclosure requirements, privacy policy, and details to be provided in the application form such as business/premises details, interests of other parties, and security measures in place.
This document is a rent certificate used to verify rent paid in Wisconsin. It provides instructions for renters and landlords to fill out the form. Renters provide identifying information and rental details. Landlords provide contact information and sign to verify the rental details. Rent amounts, number of occupants, and value of services provided are reported to calculate allowable rent for homestead tax credit claims.
This document contains a property claim form for Calliden insurance. It requests information to process a claim for loss or damage to insured property. The three-page form requests details of the policy, loss event, repair costs, previous claims history, and a declaration authorizing Calliden to process the claim. It also contains brief sections on Calliden's privacy policy and disputes resolution process.
This document is an Arizona state tax form for claiming a property tax refund or credit for the year 2005. It provides instructions for qualifying for the credit and calculating the amount. The form requests personal information and details of household income, property taxes paid, and dependents. It then uses schedules to determine the amount of the tax credit based on household income and living situation. The credit can be direct deposited or paid as a refund.
This document is an Indiana state tax return form for 2008. It provides instructions for filing as an individual taxpayer and includes sections to report income, deductions, exemptions, taxes owed or refund amount. Key details include reporting federal adjusted gross income, Indiana deductions, exemptions, state and county tax amounts, credits, payments made including withholdings, and amounts owed or to be refunded.
This document appears to be a claim form for machinery or computer equipment. It requests information such as contact details, policy details, purchase details of the damaged item, and details of the claimed loss or damage. The claimant is asked to provide payment details and attach relevant documents like invoices. If claiming for refrigerated goods, the form requests a list of damaged goods with costs. A repairer section asks for technical details of the damaged item and repairs.
This document is an insurance claim form from QBE Insurance (Australia) Limited for a machinery claim. It requests information about the insured, the incident details, the item in question, repair details, invoices and a declaration authorizing QBE to obtain information. The form must be fully completed and original invoices submitted for the claim to be processed.
This document is a Maine Form 1040X, which is used to file an amended individual income tax return. It provides instructions for taxpayers to correct their original Maine tax return. The form includes sections to report income, deductions, exemptions, payments and the refund or amount owed. Taxpayers must explain any changes on page 2 and attach supporting documents. The instructions provide guidance on filing amended returns, reporting income and deductions, and claiming refunds for deceased taxpayers.
This document is a rent certificate used to verify rent paid in Wisconsin for homestead credit purposes. It provides instructions for both renters and landlords to complete. Renters fill out basic information and give it to their landlord to verify rent details for the year. If landlords do not sign, renters can provide proof of rent paid instead. It also provides an explanation of how to calculate allowable rent amounts and includes a supplemental schedule for shared living expenses.
The document outlines insurance requirements for renting equipment from Ahern Rentals, including:
1) The customer must provide a certificate of insurance naming Ahern Rentals as an additional insured and loss payee and listing their address.
2) The certificate must show minimum liability and property damage insurance limits.
3) Ahern Rentals requires 10 days notice of cancellation of the customer's insurance policy.
This document outlines a Trades Package Insurance Policy from QBE Australia that provides business insurance covering property, general liability, tax audit, transit, statutory liability, employment practices and other areas. It details what is and isn't covered, how to make a claim, exclusions, conditions, and other important policy information. QBE is a major Australian insurer seeking to provide strong financial protection and industry-leading insurance solutions to intermediaries and their clients.
Materi Seminar Upgrading Keilmuan Tentang Diabetes mellitus "Kedokteran timur...Kurma Untuk Indonesia
Dokumen ini membahas pengobatan kencing manis menurut pengobatan tradisional Tiongkok. Kencing manis dibagi menjadi 3 jenis berdasarkan organ yang terpengaruh, yaitu Siao Atas (paru-paru dan jantung), Siao Tengah (limpa dan lambung), dan Siao Bawah (ginjal). Setiap jenis memiliki gejala khas dan titik akupresur yang digunakan untuk mengobatinya, seperti BL22, TE5, BL13, LU
This document is a commercial/retail/industrial insurance policy underwritten by QBE Insurance Australia Limited. It contains general information about the policy, details of the policy terms and conditions, and outlines the various cover sections included in the policy such as business property, business interruption, theft, money, machinery, public and products liability, glass and others. The policy is a legal contract between the insured and the insurer and must be read in full to understand the details of coverage provided.
This document outlines the terms and conditions of a general and products liability insurance policy. It includes definitions of key terms, descriptions of what is and is not covered, and procedures for claims and cancellations. Key exclusions include property owned by the insured, damage to products, faulty workmanship, asbestos, breach of professional duty, contractual liability, employers' liability, and fines, penalties or punitive damages.
This document summarizes the development of the author's Twitter account over its first month. It shows screenshots of her account with increasing numbers of followers and accounts followed over January and February 2013. The author explains how following educational organizations and colleagues has helped her connect to resources and people in the teaching field and learn more about the Alberta education system. She reflects that Twitter will help her collaborate, connect, and communicate with different people throughout her career in education.
1. This policy provides office insurance covering property, business interruption, money, glass, liability, employee dishonesty, machinery, computer equipment and other sections.
2. Key details include the insurer as CGU Insurance Limited, the policy number and period of insurance shown on the schedule.
3. The policy is subject to general definitions, conditions, exclusions and claims procedures outlined in the document. Each section also contains specific coverages, limitations, definitions and procedures.
This document provides a summary of a business insurance policy. The policy consists of multiple cover sections that can provide insurance for business property, business interruption, theft, money, machinery, public and products liability, glass, general property, employee dishonesty, goods in transit, tax probe, legal expenses, commercial motor vehicles, and other risks. The document outlines the key details, conditions, exclusions, and claims process for the policy. It is intended to help the business owner understand what risks are covered and the process for making claims.
This document summarizes a general and products liability insurance policy from Steadfast General and Products Liability Insurance. Some key points:
- It provides definitions for important terms used in the policy like "advertising injury", "aircraft", "business", and "electronic data".
- The insuring clauses describe what is covered, including legal liability for personal injury, property damage, and advertising injury from the insured's business activities. It also covers defense costs and supplementary payments.
- Exclusions are listed for what is not covered, such as aircraft, asbestos, contractual liability, faulty workmanship, pollution, and terrorism.
- The claims conditions specify requirements around notification of claims to the insurer
This document is a business claim form from QBE Insurance (Australia) Limited. It requests information about the insured, property, premises, and incident details. It asks the claimant to provide their contact information, property ownership details, description of the loss/damage, previous claims history, and security/police report information. The form is comprised of three compulsory parts: Part A requests insured details, Part B is for relevant sections depending on the claim type, and Part C requires signature and declaration.
QBE Insurance (Australia) Limited received a liability claim from an insured. The document provides instructions for submitting a claim and requests details about the incident, those involved, any injuries, property damage, witnesses, and whether police were contacted. It also notes that submitting a claim does not constitute an admission of liability and requests that the insured not admit fault. Personal information is collected in accordance with QBE's privacy policy.
The document provides a Product Disclosure Statement and Policy Wording for Vero Business Insurance. It consists of 4 parts:
1. A policy summary that outlines the different cover sections available and what they cover in 3 sentences or less.
2. Important information about the policy including cooling off periods, duty of disclosure, privacy, and making complaints.
3. Additional information for individuals or small businesses insuring vehicles or home buildings.
4. The full policy terms and conditions for each cover section, general exclusions, conditions, and definitions. It provides the details of what is and isn't covered for each section of the policy.
This document is a glass claim form for Wesfarmers General Insurance. It contains instructions for completing the form when insured plate glass is damaged. The form requests details about the policy, contact information, description of the damaged glass, and a declaration. It notes that original invoices or estimates should be attached, and that the claim will be assessed according to the policy details provided.
This document is a commercial/retail/industrial insurance policy underwritten by QBE Insurance Australia Limited. It contains general information about the policy, details the insured's duty of disclosure, and outlines the insurer and insured's agreement. The policy terms and conditions define what is covered, exclusions, conditions and more. It provides insurance for various sections including business property, business interruption, theft, money, machinery, public liability and others.
This document is an insurance claim form from QBE Insurance (Australia) Limited. It requests information from the claimant in three parts: Part A requests basic information about the insured and the claim. Part B contains sections for specific types of claims, like glass breakage, theft, or storm damage, and requests details. Part C requires the claimant's declaration and authorization. The form must be fully completed to avoid delays and allows QBE to obtain relevant details to process the insurance claim.
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Dokumen tersebut membahas tentang diabetes mellitus, termasuk definisi, jenis, faktor risiko, gejala klinis, patofisiologi, diagnosa, komplikasi, pencegahan, diet, dan pola hidup sehat bagi penderita diabetes.
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Dokumen tersebut merangkum biografi dan latar belakang pendidikan seorang praktisi akupunktur bernama Syarif Hidayat. Dokumen juga membahas pengobatan tradisional, kedokteran barat, timur, dan Islam serta konsep diabetes dan terapi bekam.
1) The claimant is seeking compensation for property that was damaged, lost, or stolen according to their property insurance policy with Allianz.
2) Key details are provided about the incident including the date and location of loss, items affected, and whether the police were notified.
3) Additional information is requested about security measures, other responsible parties, witnesses, and previous insurance claims to process the claim.
4) The claimant agrees to the privacy statement allowing Allianz to collect information to assess the claim and discloses any relevant history.
1) The claimant is seeking compensation for property that was damaged, lost, or stolen according to their property insurance policy with Allianz.
2) Key details are provided about the claimant, the insured property and items, and the incident where the loss or damage occurred.
3) The claimant is asked to provide additional information such as whether the police were notified, what security measures were in place, and if there are any other parties responsible. Witnesses to the incident are also requested to be detailed.
4) Declarations are made regarding the accuracy of the information provided and consent to collect personal information in order to process the claim.
This document is an insurance claim form requesting details about an insured, their policy, and the claim being filed. It requests information such as the insured's contact information, GST registration details, description of the loss event, details of any witnesses, a list of items being claimed for along with their value and purchase details, and the claimant's contact information. Additional sections address requests for details related to plumbing repairs, electrical damage, and a police report if the loss was reported.
This document is a general claim form for Wesfarmers General Insurance. It contains instructions for completing the form when property is lost, damaged, stolen or destroyed. It notes that temporary repairs may be necessary to protect the property. The form requests details about the insured, policy, incident details, property and repairs. It also contains information on privacy, complaints procedures and the insured's duty of disclosure.
QBE Insurance (Australia) Limited received a liability claim from an insured. The document provides instructions for submitting a claim and requests details about the incident, those involved, any injuries, property damage, witnesses, and a declaration authorizing QBE to investigate the claim. The insured is asked to provide their contact information, describe what happened and how it was reported, identify if vehicles, property, equipment or animals were involved, and sign declaring the information is true.
This document contains a liability claim form that is used to report incidents or accidents that could result in claims being made against the policyholder. It requests details about the policy, those involved in the incident, witnesses, property damage, injuries, and other insurance coverage. The policyholder must complete all sections, provide documentation, and declare that the information is true for the claim to be assessed.
The form contains sections for policy details, client details, accident details, witnesses, damaged property details, injured persons details, and a declaration. It requests information to assess a claim for any demands or liability arising from an incident. Completing and returning the form allows the insurance company to process and administer the claim in accordance with the claimant's policy.
This document provides instructions for filing a property claim with CGU Insurance. It explains that most policies allow for replacement of damaged property and lists what information needs to be included in the claim report, such as details of lost, stolen or damaged items, how the loss occurred, and whether it was reported to police. Claimants are advised not to authorize repairs themselves and to retain damaged items when possible for inspection.
The document is a property claim report form for reporting lost, stolen, or damaged property to an insurance company. It requests information to process a claim, including: the policy details, contact information, description of the incident, property details, previous claims history, and a declaration authorizing the insurer to process the claim. It informs the claimant to retain damaged items if possible and attach estimates, receipts or other documentation to support the value of items being claimed.
1) The insured has submitted a claim form to Zurich Australian Insurance Limited to lodge a written statement about an insurance claim.
2) The form requests details about the insured, the incident, ownership of damaged property, costs of repairs or replacements, and a declaration authorizing Zurich to assess the claim.
3) The insured must provide evidence of ownership and value of damaged items and is warned against exaggerating the claim amount.
The document is a general claim form from an insurance company. It requests information to process an insurance claim, including details of:
- The insured and their contact information
- How the incident occurred and details of what happened
- A description of any damaged or lost property and its value
- Whether any other parties may be responsible
- Whether the incident has been reported to police
It also provides information on how personal details will be used to process the claim, and a declaration for the insured to sign.
The document is a general claim form from an insurance company. It requests information to process an insurance claim, including details of:
- The insured and their contact information
- How the incident occurred and details of what happened
- A description of any damaged or lost property and its value
- Whether any other parties may be responsible
- Whether the insured has other relevant insurance policies
- Contact with authorities like the police, if applicable
It notes the company will collect personal information as needed to assess the claim, and may share information with third parties for this purpose.
1) The document is a general claim form from an insurance company.
2) It requests information about the claimant, their policy, and details of the incident to lodge a claim.
3) The form notes that submitting a claim does not mean the company admits liability, and requires signatures to authorize the company to collect information in assessing the claim.
1) The document is a general claim form from an insurance company.
2) It requests information about the claimant, their policy, and details of the incident to assess their claim.
3) The form notes that submitting a claim does not mean the company accepts liability, and requires signatures to authorize the use and sharing of personal information for assessing the claim.
This document is a uniform residential loan application. It is designed to collect information from applicants to assist lenders in determining qualification for loan programs. The application collects information about the applicant, co-applicant, property, loan, and employment details. It informs that income or assets from additional parties may be considered and that properties in community property states require all parties' information.
Calliden Business Pack PDS (Product Disclosure Statement / Policy Wording)InsuranceRateMonitors
This document provides an overview of the First Option Business Insurance product offered by Steadfast, including:
1) Important information about Your duty of disclosure and privacy.
2) Application forms and sections to apply for various types of business insurance coverage including property, business interruption, theft, money, glass, public liability, and optional extensions.
3) Questions to provide details about Your business, premises, security measures, and products to facilitate underwriting.
4) Sum insured limits that can be selected for different types of coverage.
The document aims to clearly outline the types of insurance available and obtain necessary information to assess and provide a business insurance quote and policy.
This document is a title agency supplement for a law firm's professional liability application. It requests information about a title agency owned by the law firm including its ownership structure, revenues, number of closings, and insurance details. It also asks whether any claims have been filed against the title agency in the past 5 years or if any circumstances could result in a future claim. The applicant must sign declaring the information provided is accurate and authorizing the application.
1) Calliden provides property insurance and operates according to the General Insurance Code of Practice. It is committed to protecting privacy and requires personal information to process claims.
2) The policyholder must provide details of their loss or damage including date, location, witnesses, security and repairs. Any previous losses or claims must also be detailed.
3) Settlement options including repair, replacement or refund are covered. The policyholder must declare any other policies covering the same property and provide their signature to authorize the claim.
This document contains a property claim form for Calliden insurance. It requests information to process a property damage or loss claim, including: [1] policy and contact details; [2] details of the loss or damage incident; and [3] information about repair costs and previous claims history. The form notes that Calliden complies with privacy laws and uses information only for processing the claim, offering other services, or as required by law. It requires signature to authorize use of the information and consent to disclosures to other parties for handling the claim.
Use this worksheet when starting the process of filing for personal bankruptcy or a personal proposal to provide to the Trustee information about your financial situation.
It can be printed, filled out, and faxed to us or you can type directly on it and email it to us.
Contact us at: 888-504-1511
or visit: http://www.djallen.ca
1. QBE INSURANCE (AUSTRALIA) LIMITED
ABN 78 003 191 035
Business Claim
The issue of this form does not constitute an admission of
liability on the part of the insurer.
Policy Number Claim Number
Please complete:
Part A — Compulsory for all claims.
Part B — Relevant sections pertaining to your claims.
Part C — Compulsory for all claims.
Part A – Compulsory for all claims.
The Insured
Business Name
Are you registered for GST? No Yes What is your ABN?
Have you claimed or intend to claim an input tax credit on the No Yes – Will you be claiming an amount less than 100%?
GST component of the premium applicable to the Policy? %
No Yes – Specify amount claimed
Are you entitled to claim an input tax credit for repairs or No Yes – Will you be claiming an amount less than 100%?
replacement of the item that has been lost or damaged? %
No Yes – Specify amount claimed
Nature of Business
Address
State Postcode
Business ( ) Private ( )
Contact Numbers
Facsimile ( ) Mobile
The Property
Are you the owner of the property being claimed for? Yes No — Give details
Was there any other insurance covering this damage current at the time of the occurrence? No Yes — Give details
Name of Insurer Policy Number
Does any other party have an interest in the damaged property the subject of the claim? No Yes — Give details
(e.g. Mortgagee, Finance Co. leasee)
Name Telephone ( )
The Premises
Where did the loss or damage occur?
Address
State Postcode
Describe the premises (i.e. Factory, Warehouse, Office Block etc.)
Are the premises tenanted? No Yes — Give details of tenant?
Are you the tenant? No Yes — Give details of building owner?
Were the premise occupied at the time of the loss? Yes No — Give details of when last occupied
Name Hour Day Date / /
QM118-0806
2. Incident Details
Day and Date of Incident / / Between the hours of am/pm am/ pm
How did the damage/loss occur?
Was another person responsible for the damage? No Yes — Give details
Name
Address
State Postcode
Details of Previous Loss or Damage
Have you ever suffered any loss, damage or theft at this address or elsewhere in the last 5 years? No Yes — Give details
Describe loss, damage or liability Date Amount
/ / $
/ / $
/ / $
/ / $
/ / $
/ / $
/ / $
/ / $
/ / $
/ / $
/ / $
Have you made a claim on any insurer for any of the above mentioned incidents? No Yes — Give details
Insurer Date Amount
/ / $
/ / $
/ / $
/ / $
/ / $
/ / $
/ / $
/ / $
/ / $
/ / $
Part B – Complete relevant sections pertaining to your claim.
Breakage of Glass — Please attach invoice or quotation
What was broken?
Was the break through the entire thickness of the material? Yes No
Has the break been repaired? Yes No If yes, have you paid the account? Yes No
Was there damage to window signwriting? Yes No
3. Storm and Water Damage
Describe the damage
How did the Wind, Rain or Water enter the premises?
Did the storm cause this opening? No Yes — give details
Theft or Burglary – Please attach original purchase dockets, invoices or receipts. If you provide as much proof about owning the
items it will help us to process your claim quickly.
How were the premises entered and where was the point of entry?
Which parts of the premises were entered?
Have the police recovered any property? No Yes — give details
Security Details
Are any of these used to provide security to the premises?
Keyed window locks on all Grilles on all accessible
accessible windows windows and doors Fixed Safe
Double keyed deadlocks
on all perimeter doors Perimeter Alarm Free standing safe
Back to base
(please attach activity report) Internal Alarm None
Did the device activate as a result of theft? No Yes
Any loss involving malicious damage, lost or stolen property must be notified to the police.
Police Details
Have the police been notified? No Yes — by whom
Name Telephone ( )
Police Station Date notified / /
Crime Report No.
Please attach a copy of Police Report, if available.
If the damage is the result of fire did the fire brigade attend? Yes No
4. Part B – Complete relevant sections pertaining to your claim.
Details of Claim – Please attach quotations. If insufficient space please attach list and show total amounts only below.
DAMAGE BUILDING
Particulars Name of Repairer Amount Claimed
$
$
$
$
$
$
$
$
TOTAL $
LOSS OR DAMAGE TO OTHER PROPERTY
Description of Property Value at Replacement Value
Where Purchased ( When Purchased
(Include serial number) Time of Loss (attach quotes)
/ / $ $
/ / $ $
/ / $ $
/ / $ $
/ / $ $
/ / $ $
/ / $ $
/ / $ $
/ / $ $
/ / $ $
/ / $ $
/ / $ $
/ / $ $
/ / $ $
TOTAL $
We are not responsible for payment of invoices, however, please indicate if you request payment to any other party.
Privacy
QBE includes information about how we manage your personal information in our Product Disclosure Statements and Policy booklets. You can
obtain a copy of the QBE Privacy Policy Statement from our website www.qbe.com or contact the Compliance Manager on 02 9375 4656
or email compliance.manager@qbe.com for further information.
Declaration and Authorisation
The information and answers given above are true, correct and complete in every detail.
1. I/We understand the claim may be refused if information is not true or is withheld.
2. I/We authorise QBE Insurance (Australia) Limited to give to and obtain from other insurers, insurance reference bureaus and credit reporting
agencies any information relating to the Insured’s credit or insurance history as well as insurance claims information obtained during the
course of this contract.
Signature of Insured 1. X Date / /
Signature of Insured 2. X Date / /
PLEASE CHECK THAT THIS FORM HAS BEEN FULLY COMPLETED AS ANY OMISSIONS MAY DELAY YOUR CLAIM.
Return the completed form to your Financial Services Provider or mail to QBE Insurance, GPO Box 4229, Sydney NSW 2001.
This Policy is underwritten by QBE Insurance (Australia) Limited ABN 78 003 191 035 of 82 Pitt Street, Sydney.