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 Documents Only (.docx)

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