Claims

Motor Vehicle Personal Accident Burglary Goods-In-Transit Fire/ Special Peril Marine Vessel Marine Cargo Hull Risk Fidelity Guarantee Contract Work

Vehicle Claim

INSURED’S VEHICLE INVOLVED IN THE ACCIDENT

DRIVER at time of accident

CIRCUMSTANCES OF ACCIDENT

WITNESSES

DAMAGE TO INSURED’S VEHICLE

Where the Policy provides cover for damage to the insured’s vehicle a detailed repair estimate should be submitted as soon possible but repairs should not be done without the approval of the Company unless within the limit permitted by the Policy

The Details of the Third Party Vehicle

If any written communication is received please forward it immediately unanswered

If the current premium has been paid please state

By submitting the form I/We declare that the foregoing particulars are true in every respect and I hereby permit the company in accordance with the Conditions of the Policy to conduct all claims and litigation arising out of this accident and to which the Policy applies, to deal with, to prosecute and/or settle as they think fit without further reference to me and I undertake to give all such information and assistance as the Company may require.

PERSONAL ACCIDENT CLAIM FORM

PERSONAL ACCIDENT CLAIM FORM

Please note that the issue of this form does not show acceptance of liability by insurer

Statement of Claim

Remember to allow for age, use, wear and tear in the amount you are claiming

By submitting this form, I/We hereby declare that the property claimed for and particulars given above has been lost or damaged and that all statements on this form are, to the best of my/our knowledge and belief correct.

BURGLARY/THEFT CLAIM FORM

BURGLARY/THEFT CLAIM FORM

GOODS IN TRANSIT CLAIM FORM

GOODS IN TRANSIT CLAIM FORM

 

Statement of Claim

Remember to allow for age, use, wear and tear in the amount you are claiming

By submitting this form, I/We hereby declare that the property claimed for and particulars given above has been lost or damaged and that all statements on this form are, to the best of my/our knowledge and belief correct.

FIRE/SPECIAL PERILS CLAIM FORM

FIRE/SPECIAL PERILS CLAIM FORM

By submitting this form I/We declare that the above is a full and accurate

MARINE VESSEL CLAIM (#25)

MARINE VESSEL CLAIM FORM

Please note that the issue of this form does not show acceptance of liability by insurer

IMPORTANT

 

1          Have you sent estimate of repairs to the company? If not do so at once

 

2          Machinery: whenever machinery has been wetted it should be opened up immediately, flushed out and inhibited with oil

 

3          Theft: If theft is involved Police should be notified immediately

 

4          Salvage Services: If such service was rendered to your vessel give details and names and addresses of persons rendering the service

By submitting the form we declare the foregoing particulars are true and correct and hereby undertake to render assistance within our power in dealing with the matter.

MARINE VESSEL CLAIM (#25)

MARINE VESSEL CLAIM FORM

Please note that the issue of this form does not show acceptance of liability by insurer

IMPORTANT

 

1          Have you sent estimate of repairs to the company? If not do so at once

 

2          Machinery: whenever machinery has been wetted it should be opened up immediately, flushed out and inhibited with oil

 

3          Theft: If theft is involved Police should be notified immediately

 

4          Salvage Services: If such service was rendered to your vessel give details and names and addresses of persons rendering the service

By submitting the form we declare the foregoing particulars are true and correct and hereby undertake to render assistance within our power in dealing with the matter.

MARINE VESSEL CLAIM (#25)

MARINE VESSEL CLAIM FORM

Please note that the issue of this form does not show acceptance of liability by insurer

IMPORTANT

 

1          Have you sent estimate of repairs to the company? If not do so at once

 

2          Machinery: whenever machinery has been wetted it should be opened up immediately, flushed out and inhibited with oil

 

3          Theft: If theft is involved Police should be notified immediately

 

4          Salvage Services: If such service was rendered to your vessel give details and names and addresses of persons rendering the service

By submitting the form we declare the foregoing particulars are true and correct and hereby undertake to render assistance within our power in dealing with the matter.

FIDELITY GUARANTEE CLAIM

FIDELITY GUARANTEE CLAIM FORM

Please note that the issue of this form does not show acceptance of liability by insurer

Damage/Loss (Describe)

By submitting the form we declare the foregoing particulars are true and correct and hereby undertake to render assistance within our power in dealing with the matter.

CONTRACT WORK CLAIM FORM

CONTRACT WORK CLAIM FORM

Please note that the issue of this form does not show acceptance of liability by insurer

The Contract

Damage/Loss (Describe)

Third Party Damage

Police report is necessary if Crime is involved. Pictures of the scene/damage is also necessary including newspaper cuttings where available

Repair/Replacement Cost:

Third Party Compensation Costs (if any)

Premium Payment:

By submitting this form, I/We hereby declare that all statements on this form are, to the best of my/our knowledge and belief correct.

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