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Public/Products Liability Incident Report

Notes – The Issue of this form does not constitute an admission of liability on the part of the Insurer.

If anyone holds you responsible for their accident/injury, insist their claim must be in writing
Any communication received must be forwarded immediately
Do not admit liability

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For over 40 years, AIB has been providing our clients across Australia with peace of mind that their business, assets and reputation are well protected and supporting them if things do go wrong.

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Public/Products Liability Incident Report

General Details

GST Details

Third Party

Particulars of Accident / Incident

Property Liability- (if applicable, please complete the following)

Property Damage - (if applicable, please complete the following)

Personal Injury - (if applicable, please complete the following)

Witnesses

Witness 1

Witness 2

Police

Signature & Declaration

Settlement By Direct Debit