Resources

HOP Insurance Claim Form

Please fill out the form below and a customer representative will be in touch with you within 48 - 72 hours.

Personal Details

Full Name:*

Address:

Town:

Phone:

Payroll ID:

Please advise description of claim

Item

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(eg. Compressor)
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Description of Problem

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(based on qualified repairer's report)
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You must attach an itemised invoice and written explanation of what caused the problem from the repairer. If this is not supplied your claim will not be able to be processed.

Is this the first claim you have made?

Yes

If no, please provide details of last claim:

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Please state the year and a brief description of the problem
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Declaration

I declare the information provided above is true and accurate. I understand that the money paid to me is for me to pay the contractor directly, along with any other monies due but not insured by Pilbara Iron.

Employee Code of Applicant:

Date:

* Required Field