Claim Form

When completing this form, please ensure all available supporting documentation is attached. When complete, please click the ‘submit’ button.

    Policy Number

    Policyholder:

    Name of Claimant

    Property Address:

    Correspondence address (If different from above)

    Contact Number

    Contact email:

    State the nature of your interest in the property being claimed for, i.e Owner, tenant

     

     

    Is the dwelling a: (delete as applicable)

     

    Flat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .

    YesNo

    Maisonette . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    YesNo

    Apartment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    YesNo

    House. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .

    YesNo

    Garage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    YesNo

     

     

    CLAIM DETAILS 

     

    Date of incident

    Describe what happened, circumstances under which discovered and by whom:

    Attach Photographs and Estimates - Word or PDF Documents / JPG Images / MP4 Video Files Permitted

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