Details
Name:  
Policy Number:
Address:  
Renewal Date:
Telephone No:  
Occupation:
Are you registered for VAT purposes?
If Yes; VAT No:
Please give the following information about the loss/damage
When did it happen? a.m/p.m
on:
Where did it happen?
How did it happen:
If the damage is to the building, please state:
Age of building:
Briefly the extent of the damage:
Are you insured under any other policy for this loss?
If Yes; please give the Insurers name:
Has anyone else a financial interest in the property, i.e. as owner or under a mortgage?
If Yes; please give details:
Have you ever before made a property claim on an insurer?
If Yes; please state: Nature of Claim:
Name of Insurers:
Amount Paid:
In case of theft, please give the following information about your premises:
How were they entered?
Were they occupied at the time?
If No; when were they last occupied?
Were they furnished for full habitation?
In case of theft, or loss or malicious damage, please state:
The date you informed the police:
The address of the police station:
The police reference on any document given to you:
Please give the estimated total value of your property at the time of the loss:
Buildings:
Full rebuilding cost:
All the Contents:
Full replacement value:
CLAIMS & UNDERWRITING EXCHANGE CLAIMS & UNDERWRITING EXCHANGE
Insurers and their agents share information with each other to prevent fraudulent claims and for underwriting purposes via the Claims and Underwriting Exchange Register, operated by Insurance Database Services Limited. A list of participants is available on request. The information you supply on this form, together with the information you have supplied on your application form and other information relating to the claim, will be provided to participants.
INSTRUCTIONS TO BE OBSERVED

All damaged property must be protected from further deterioration and should not be disposed of until permission is given by the Company or the Loss Adjusters.

BUILDINGS:
The claim form should be accompanied by a Tradesmans original detailed estimate.

CONTENTS & STOCK:
A list of the articles destroyed, stolen or damaged should be detailed below. Please indicate if any item you are claiming, e.g. a television received, is on hire. It will help us to deal with your claim if you give us as much information as possible in respect of the lost, stolen or damaged item, i.e. MAKE - MODEL - SERIAL NUMBER
 
DESCRIPTION OF PROPERTY FOR WHICH THIS CLAIM IS MADE
DATE OF PURCHASE
COST OF REPLACING THE PROPERTY
VALUE AT TIME OF LOSS OR DAMAGE AFTER ALLOWING (WHERE APPROPRIATE) PREVIOUS WEAR AND TEAR
VALUE OF SALVAGE
AMOUNT CLAIMED, I.E. ACTUAL LOSS AFTER DEDUCTION OF SALVAGE VALUE
Column 4 need not be completed if the item concerned is insured on full cost of replacement basis
TOTAL
DECLARATION
If you make a claim, which is any way fraudulent, unfounded or exaggerated, or make a false declaration, all benefit under this policy will be forfeited.