Report a Loss

To notify ACM Ahlers of your loss please complete the information on the form below.

We'll contact you within 24 hours to arrange for the processing
of your claim and to assist you with repairs etc.

If you have any queries or require assistance please contact us on 0800 222 164.

This service is only available to clients residing in New Zealand. Any information provided by you is treated as strictly confidential and will not be kept on any database or used by us for any other reason than assisting you with this claim. Please note you may still be required to complete an additional claim form.

Your Contact Details

Insured Name

Please enter the Insured Name

Your Name

Please enter your name

Your Phone

Please enter your phone number

Your Email

Please enter a valid email address

Type of Insurance Policy

Please Select Motor Insurance Home Insurance Contents Insurance Boat Insurance Business Insurance Other

If a Motor Vehicle, please give details

Make

Model

Registration No.

Estimate of loss

Please include the date loss/damage below:

Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Month January February March April May Jun Jul August September October November December

Year 2012 2011

What happened? Please include a brief account

Where did it happen?

Once you have completed this form, please check to make sure you have answered all the questions and that your details are recorded correctly. Then press the Submit button. We will contact you within 24 hours.

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