Type of compensation sought
Please select the type of compensation being sought:
Select type of compensation being sought
Contact details
Title
Correspondence
Do you agree for all correspondence to be sent to you by email?
Incident details
Address including suburb and closest cross street/s to the incident
Did you contact Council staff at the time of the incident?
Compensation sought
Please also note that the request of this information must not be seen as an automatic acceptance of liability. All claims are assessed based on their own merit and any payments made will come from Council funds.
For property/vehicle damage claims, attach any supporting documentation to substantiate your loss. Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png pdf doc.
Insurance details
Have you claimed against your insurer?
Witness details
Did anyone witness the incident?
Please attach a witness statement. Note: Council will not contact the nominated witness should a statement not be attached. A decision will be made in the absence of such evidence Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.
Evidence
To progress your claim for compensation you will need to establish Council caused the alleged loss and/or damage through some form of negligence. In any public liability claim, the burden of providing proof of negligence rests with the person seeking compensation. Council cannot assist. If your claim is for a tree or pothole related matter, please refer to the tree or pothole evidence page on the website for the required information.
Is the evidence attached to this form?
Attached evidence Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.
Photos
Have you attached photos?
Attach photos Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png.
Authority for an agent to act
Do you wish for a third party to act on your behalf in this claim?
Electronic confirmation
Council will investigate the circumstances surrounding your claim to establish whether or not Council has any legal liability. Completion and acceptance of this form does not represent an admission of liability or a waiver of its rights on the part of Council. Your claim will be subject to investigation and the findings assessed on their own merits. Council will endeavour to respond to claims as quickly as possible. However the processing of claims is dependent on the supply of relevant information and assessment of your claim may take some time to complete.
I confirm the information is correct *