**Furniture Insurance Claim

Welcome to SuperShield Claim System, Please fill in the following details

Before filling in this claim form please read the warranty detail in relation to your lounge to ensure the damage to your lounge is covered by the Supershield warranty. If you are covered please proceed with your claim by providing ALL the information requested, NOTE all section MUST contain a response your claim cannot be submitted if section are left unanswered.

You can only make a claim for damage to your lounge if you are the original purchaser of the lounge and you name and address appears on the invoice;

CUSTOMER DETAILS
Name Insured:
Home Phone Number:
Email Address:
Mobile Phone Number:


Address:
Suburb:
Postcode:
Date of complaint:

LOUNGE DETAILS

Item Insured: (Full Description) :
Fabric Type:		Colour:
Original Purchase Price:		Item description:

RETAILER DETAILS
Retail Outlet		Date of delivery:
Original Invoice No:		Please provide a copy of your invoice from the retailer of the lounge:

	WARRANTY DETAILS 5 years on the Fabric 5 years on the Foam 5 years on the Frame 5 years on the Stitching 5 years on the Recliner Mechanism 5 years on Accidental Single Cigarette Burn 5 years on an Accidental Rip 5 years on an Accidental Tear 5 years on Permanent Staining 5 years on Permanent Staining for common household items.
Who do you believe is responsible for the damage to your lounge?
Full details of damage to lounge and how damage occurred:
	Unless previously specified. * DAMAGE NOT COVERED: * Any damage caused by pets, rodents, animals, * Damage caused by misuse. * Damage caused in transport. * Peeling or cracking * Dye transfer * Damage otherwise covered by household insurance.