Submit Your Claim


Country *

Policy Number

Insured's First Name *

Insured's Surname *

Tel (Home)

Mobile Number *

Tel (Work)

Other Contact Number

Email Address *

Postal Address *

Loss Location (with directions) *

Were the premises occupied at the time of the loss? *

What were the premises being used for? *

Are you the sole owner of the property? *

Are there any other insurances on the property?

Please give full particulars

Description of Loss

If you wish to submit photos of your loss, please upload below
By submitting this form, I do hereby declare that the above is a true and accurate statement with respect of the above loss.