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Notice of Claim Form

 
1 Contact Details 2 Insurance Details 3 Damage Details 4 Preferred Contact Time 5 Your Submission
Contact Details

In order to complete this Notice of Claim Form, you will need to provide your contact details, private insurance details, and a description of the natural disaster damage that has occurred. If you are not the Insured for this property you will need to provide the policy holder's details.

The information provided in this form will be used for the purposes of fulfilling EQC’s functions under the Earthquake Commission Act 1993, including managing, assessing and settling your claim. It may also be used for training, research, and statistical purposes.

For more information about how EQC manages customer information, please see our Privacy Policy.

Contact Address
Insurance Details
  • If you have damage to contents, please provide information about your contents insurance.
  • If you have damage to land or dwelling, please provide information about your dwelling insurance.
Address of the Policy Holder
Contents Insurance
Dwelling Insurance
Damage Details
  • You have selected contents damage; please make sure the "Contents Insurance" section on the previous page is completed.
  • You have selected dwelling damage; please make sure the "Dwelling Insurance" section on the previous page is completed.
  • You have selected land damage; please make sure the "Dwelling Insurance" section on the previous page is completed.
Damage Address
What is the address where the damage occurred?
Preferred Contact Time
Your Submission

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