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    • About Us
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  • Why Landcover
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Liability Claim Form

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Landcover Ref No: 10M 6612460

Need Help with this form ? Call Landcover Support 1300 526 326

  • Important notice

    No admission of liability, either implied or expressed, should be made. Any claim made upon you should simply be acknowledged with advice that the matter has been referred to your insurer for determination. The completion of this form and its receipt by CGU is not an indication that CGU accept any liability to you or to any person claiming from you.

  • Insured’s details

  • Claim details

  • :
  • General information

  • Full nameTelephone no.Address 
  • NameAddress 
  • Injured person(s) details

  • Property damaged details

  • Drop files here or
    Max. file size: 64 MB.
    • Declaration

      I/We declare that the said loss occurred without my/our knowledge or consent and that I/We have not sought to benefit unjustly from this claim by fraud, wilful misrepresentation or exaggeration.

      I/We declare that the information supplied on this claim form is true in every respect.

      I/we agree that, by submitting this form, the personal information I/we provide to CGU Insurance in this form or otherwise may be collected, held, used and disclosed in the manner set out in the CGU Privacy Policy found at www.cgu.com.au/privacy, including for processing this claim.

    • Drop files here or
      Max. file size: 64 MB.

      Landcover Pty Ltd ABN 67 119 345 461 is an Authorised Representative (311341) of Multi-Functional Policies Pty Ltd ACN 054 829 999 Australian Financial Services No. 241685 Copyright © 2021.

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