Damage/Loss Claim Form – Host - Happy Homestay Adelaide

Damage/Loss Claim Form - Host

Please enable JavaScript in your browser to complete this form.

Host Name

First

Last

Host Email

Phone

Homestay Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Student Name

First

Last

Student Email

School name

Date of Damage / Loss occurred

The total cost of repair / replacement

Description of Damage / Loss

Evidence - Photo of Damage / Loss

Click or drag files to this area to upload. You can upload up to 3 files.

Repair / replacement Invoice

Click or drag files to this area to upload. You can upload up to 3 files.

Homestay Host Signature

Clear Signature

Date

Homestay Student Signature

Clear Signature

Date