Area/ Academic Unit:
Contact Person for Claim:
Date of Loss:
Cause of Loss:
Description of Incident:
Damage Caused:
Action Taken to Make Premises Safe (if applicable): i.e. contractors engaged to make emergency repair
Estimated Value of Loss:
Cost Centre: Consider if a separate cost centre should be set up for this claim.
Attach any additional information: evidence to support loss /files/images: Note: Documents and evidence of loss will be required to support any loss claimed.
Other relevant Information:
Important Information to know when submitting a claim:	The insurer may appoint a loss adjuster to review the claim. The policy is one of reimbursement, costs are reimbursed after they have been incurred. Replacement quote will be required for items on a “like for ‘like” basis $10k excess is borne by Academic Unit / Business Unit cost centre A record should be kept of the time spent by you and your staff in relation to handling the claim – Staff costs are not claimable unless prior approval is given by the insurer before costs are incurred.
UniSA Insurance Office (08) 8302 1678 Email: insurance@unisa.edu.au