Confirmation of Claim Transaction request form

Confirmation of a Claim Transaction is provided after a claim is finalised for Residential Strata claims. A Confirmation of Claim Transaction regarding a settlement amount can be provided, on request by your insurance broker.

Insured Name *

Insured Address *

Address Line 1

City

State / Province / Region

Postal Code

Axis Policy Number *

Period of Insurance *

Axis Claim Number *

Confirm only the last four digits of the Account Number Axis made the payment to *

Confirm the claim settlement amount that Axis paid *

Company Name *

Broker Contact *

Phone *

Broker Claim No. *

Email *

Comments

By submitting this Confirmation of Claim Transaction request form to Axis, I/We declare that I have the authority to make this request and agree to provide further information to Axis if needed.
I consent to Axis using the personal information I have provided on this form for the puposes of processing my request in accordance with the Axis Privacy Policy.
I understand that if I do not provide the required or accurate information, my request may not be processed until we receive the required information.