Phone Insure

Section One - Claim Details

Please fill out the following details:

Claim Notification Date:

Title*:

First Name*:

Surname*:

Date of birth (DD/MM/YYYY)*:

Daytime contact no*: Your claim may be delayed should you not provide relevant contact points during business hours

After hours contact no:

Email*:

Confirm Email Address*:

Would you like to authorise another person(s) on your insurance claim?*: Only Authorised person/s can assist and discuss your claim on your behalf.

Authorised Person 1 Title*:

Authorised Person 1 First Name*:

Authorised Person 1 Surname*:

Relationship to Authorised Person 1*:

Authorised Person 2 Title:

Authorised Person 2 First Name:

Authorised Person 2 Surname:

Relationship to Authorised Person 2:

Address Line 1*:

Address Line 2:

Address Line 3:

Suburb*:

Postcode*:

State*:

If your delivery address is different to your postal address, please enter details below.

We require a postal address where the device can be delivered and signed for during business hours of Monday to Friday 8:00am to 6:00pm.

Risk Insure will not be responsible once the package has been signed for at your location. Should you provide an address that is unattended your package may be sent to your local depot or post office and you will need to arrange collection at your own time and expense.

Deliveries are not accepted to PO Boxes

My postal and delivery addresses are the same

Delivery Address Line 1:

Delivery Address Line 2:

Delivery Address Line 3:

Delivery Suburb:

Delivery Postcode:

Delivery State:

Insured Mobile Number*:

Insured IMEI Number / Serial Number*:

You can locate the IMEI via your contract, purchase receipt, original packaging/box, dialing "#06#", on your SIM tray or under your battery at the back of your handset.

Has your device been exchanged under warranty or repair?*:

Make/Model of Device*:

Colour of Device*:

Date of Incident (DD/MM/YYYY)*:

Time of Incident (HH:MM AM/PM)*:

Incident Location*: (please be specific, for example park, vehicle, shopping centre)

Was your device in your possession?*:

Who was in possession of your device at the time of the incident?:

What type of claim do you wish to make?*:

Insurance Online Claim Form