Insurance Claim

Marcus Clarke General Assurance Company Group

“We’ll look after you for the term of your natural life!”

© Ana-Clarise Rueda

© Ana-Clarise Rueda

Insured Statement Section Policy Number: 18671922 

Third Party Fire and Snake

Injured Person to Complete This Part

Insured Member’s Full Name: The Drover’s Wife

Date of Birth: 01/07/1866

Occupation: Mother

Address: ‘Dundrovin’, Nineteen Miles from Main Rd, Woop Woop, NSW 2422

Injury Details

Date of Accident: 01/07/1896

Date first treated by Doctor: N/A

Where did the accident occur?: The kitchen

Describe injury: Burns to arms

Describe fully how accident occurred: Earlier in the day, a black snake had gone under the house. When it came out, I beat it to death with a stick, and threw it on the fire. Unfortunately, this resulted in extensive second degree burns to my hands.

List any previous claims during the life of this policy, and outcome of claim:

05/09/1889: Claimed for damage to property during the Great Flood of ’89. Claim was rejected as damage was deemed to be from rain, not floodwater.

11/11/1892: Claimed for damage to property during bushfire. Claim rejected as premiums were not up to date.

17/02/1895: Claimed for post traumatic stress after being attacked by mad bullock. Claim investigated and rejected when body of bullock could not be produced.

27/01/1896: Claimed life insurance for spouse. Claim pending.

I certify to the best of my knowledge that the statements made above are true, correct and complete.

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