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Intermediary Login
Claims
Windscreen Claim Notification
Hollard Claims Administration
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Windscreen Claim Notification
1. Policy holder information
Policy holder name
What is your policy number?*
Are you a Business or an Individual?*
Business
Individual
Business Name (optional)
First name*
Surname*
Policy holder address
Street Number
Street Name
Street Type
- Select -
Avenue
Boulevard
Circuit
Close
Corner
Court
Crescent
Drive
Gardens
Heights
Highway
Parade
Parkway
Road
Street
Way
----------
Alley
Approach
Arcade
Brow
Bypass
Causeway
Circus
Copse
Cove
End
Esplanade
Flat
Freeway
Frontage
Glade
Glen
Green
Grove
Lane
Link
Loop
Mall
Mews
Packet
Park
Place
Promenade
Reserve
Ridge
Rise
Row
Square
Strip
Tarn
Terrace
Thoroughfare
Track
Trunkway
View
Vista
Walk
Walkway
Yard
Suburb*
Postcode*
State / Territory
- Select -
NSW
ACT
VIC
QLD
NT
SA
WA
TAS
Your Contact Details
Are you the policy holder?*
Yes
No
First name*
Surname*
Mobile
Home Phone
Work Phone
Email*
Your preferred method of contact*
Mobile
Phone
Email
Best time of day to contact you
AM
PM
Nominate a representative to speak on your behalf
2. Claims details
Incident Information
Car registration number*
Date the incident occurred
Tell us in detail what happened*
Is the damage to the front windscreen in the driver's line of vision?*
Yes
No
What is the size of the damage?*
- Select -
Small chip (smaller than 20 cent piece)
Large chip (greater than 20 cent piece)
Small crack (diameter smaller than 20 cent piece)
Large crack (diameter greater than 20 cent piece)
Whole glass panel