BOOKING REQUEST
ICR BUSINESS HOURS: Monday - Friday 8am - 7pm (ACST)
REQUESTER CONTACT DETAILS
(Person responsible for approving this stay - this cannot be the policyholder)
First Name
*
Last Name
*
Company Name
*
Email
*
Phone
*
INSURER DETAILS
INSURER
*
CLAIM#
*
Billing Address
*
ABN
*
POLICYHOLDER DETAILS
Policyholder First Name
*
Policyholder Last Name
*
Policyholder Phone Number
*
Policyholder Email
*
Policyholder Address
*
PROPERTY REQUIREMENTS
Home Suburb
*
State
*
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Work/Preferred Suburb
Adults
*
1
2
3
4
5
6
Children Ages 2-12
*
0
1
2
3
4
5
6
Infants Under 2
*
0
1
2
3
4
5
6
Pets (Dog, Cat)
*
*Please specify what breed and size of each pet
Bedrooms
*
1
2
3
4
5
Bathrooms
1
2
3
4
Carparks
*
0
1
2
3
4
Pet Policy
Total Approx. Budget
$100-$1,000
$1,000-$2,000
$2,000-$3,000
$3,000-$4,000
$4,000-$5,000
$5,000-$6,000
$6,000-$7,000
$7,000-$8,000
$8,000-$9,000
$9,000-$10,000
$10,000-$15,000
$15,000-$20,000
$20,000-$25,000
$25,000-$30,000
$30,000-$40,000
$40,000-$50,000
$50,000+
*This will help in finding the right property for you
Is Emergency Accommodation Required?
*
Yes
No
N/A
*If request is submitted outside of business hours. It will NOT be actioned until the next business day
Is this a CAT Claim?
*
Yes
No
N/A
CAT Event Number
Check in Date
*
Check out Date
*
NOTES
BUSINESS HOURS: Monday - Friday 8am - 7pm (ACST)
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