Crop Claim Form

We understand the challenges you face when your crops are affected. We're here to ensure your claims process is fast and hassle-free. Complete our claim form below to begin.

Step 1 of 3

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Policy Details

Policy Number

Best Contact Person (if not the insured, relationship to claim)(Required)

Phone(Required)

Are you registered to GST claim?

Yes

ABN number

Do you intend to claim any Input tax Credit (ITC) on the GST applicable to this policy?

Yes

Specify percentage claimed

Incident Details

Date of incident(Required)

DD slash MM slash YYYY

Time of loss(Required)

Hours

Minutes

AM/PM

Affected Farms(Required)

Affected Paddocks(Required)

Have you been able to visually inspect the crops yet to confirm damage?(Required)

Yes

Roughly what percentage of the crop has been damaged?

In your opinion, is damage minor, moderate or severe?

Growth stage (i.e first emergence, flowering, windrowed etc)?

Harvesting Note

If you are harvesting and need to continue harvesting, please leave strips (approx. 3m by 10m), one in each corner (10m from the boundary) and one in the middle. This will enable your assessor to inspect these crops at a later date.

Declaration

Are you the policy holder or are you lodging this on behalf of someone else?(Required)

I'm the policy holder

Behalf of someone else

I/We declare that to the best of my/our knowledge and belief the information in this form is true and correct and I/we have not withheld any relevant information. I/We understand providing false information could result in this claim and potentially this insurance policy being declined/cancelled.

I/We consent to the insurance company using my personal information I/we have provided on this form for the purpose of processing my claim. I/We understand that if I/we choose not to provide required details, this is my/our choice, however, the insurance company may not be able to process my claim.

I/We consent to the insurance company disclosing my personal information to other insurers, an insurance reference service or as required by law. I/We consent to the insurance company also disclosing my personal information to and/or collecting additional information about me, from investigators or legal advisors.

Name(Required)

Date(Required)

DD slash MM slash YYYY

Signature(Required)

Additional claim notes

Declaration on behalf of

If your claim is being filled out by someone other than the policy holder.

Name(Required)

Date(Required)

DD slash MM slash YYYY

Signature (Behalf of)(Required)

Additional claim notes

Comments

This field is for validation purposes and should be left unchanged.