Willis Temby | Windscreen Claim

Windscreen Claim

Submit a windscreen claim by completing and submitting this form. A representative from Willis Temby will get in contact with you as soon as possible. For immediate assistance, please contact our office on (08) 9227 8233.

Please enter your name.

Please enter your e-mail.

Please enter your contact number.

Please enter your address.

Please enter your policy number.

What is the expiry date of the policy? (leave blank if unsure)

What is the insured name on the policy?

Are you registered for GST Purposes?

If yes, what is your ABN?

Have you claimed or do you intend to claim an input tax credit on the GST applicable to this policy?

If yes, what is the percentage claimable?

Please enter registration number of vehicle.

Please enter the year, make, model and body type of vehicle.

What date did the accident occur?

What time did the accident occur? (approximate)

How did the accident happen?

I declare that to the best of my knowledge and belief that the information in this form is true and correct, and I have not withheld any relevant information.

By checking this box, you acknowledge that you are digitally signing as the insured, or as a person with authority to sign for and on behalf of a company or partnership.

I have read and accept Willis Temby's Privacy Policy.

Address

Thank you for your submission. A representative from Willis Temby will be in contact with you shortly. For immediate assistance, please contact our claims team on 08 9227 8233.

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For all other claims, please contact us.

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Windscreen Claim

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