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LPLC's policy requires immediate written notice to be given by the law practice of any claim or circumstance which may give rise to a claim.

Please use either our online form or download our fillable pdf form to notify a claim or circumstance to LPLC.

STRICTLY CONFIDENTIAL

LAW PRACTICE DETAILS

Only include Trading name if different from law practice entity name.
Number and street | suburb or town | state | postcode
For LPLC to obtain additional information
Contact person email address. A copy of this form, once submitted, will be automatically emailed to this address.
Best contact number

CLAIMANT DETAILS

Number and street | suburb or town | state | postcode

BRIEF DETAILS OF (a) CLAIM OR (b) CIRCUMSTANCE

If Yes go to (a) Claim. If No go to (b) Circumstance.

(a) Claim

A claim is a demand for, or assertion of a right to, civil compensation of civil damages or an intimation of an intention to seek such compensation or damages.

Attach copies of any supporting documents detailing the claim (eg copy of letter of demand, legal procedings. NOTE: All files must be uploaded simultaneously.
Can be an approximate sum or 'unknown'.

(b) Circumstance

A circumstance is an incident, occurrence, fact or matter which may give rise to a claim.

Attach copies of any supporting documents outlining the circumstance giving rise to the notification. NOTE: All files must be uploaded simultaneously.
Date DD/MM/YYYY and short description

PERSON(S) HANDLING THE MATTER AT THE TIME OF THE ACT OR OMISSION GIVING RISE TO THIS CLAIM OR CIRCUMSTANCE

Full name(s)

TOP-UP INSURANCE

You should notify top-up insurers of any claim or circumstance, however small. 

Notice to LPLC does not constitute notification to top-up insurers. Separate notification should be arranged through your insurance broker.

ACKNOWLEDGEMENT AND CONSENT

Full name.
Best contact number
Email address of person submitting this form. A copy of this form, once submitted, will be automatically emailed to this address.

Acknowledgement and consent

  • To the best of my knowledge the information in the form is true and correct.
  • I acknowledge that LPLC receives this form without prejudice to its right to determine indemnity pursuant to the terms of the law practice's policy of insurance with LPLC.
  • I consent to the collection, use and disclosure of the information disclosed in this form in accordance with LPLC's Privacy Policy.

IMPORTANT

Please download this form to your desktop, or other device first before completing, saving and forwarding to LPLC.

All entries will be lost if the form is completed in a browser view without being first downloaded.

Please contact us if you need any further assistance.

Notification of claim or circumstance to LPLC.pdf

(PDF, 92.42 KB)

IMPORTANT: Download before completing, saving and sending to LPLC.

Download Notification of claim or circumstance to LPLC.pdf