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General
Claims
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Office / Shop
Policy Information
Policy No.
Invalid Policy No.
Policyholder
Please provide a valid Holder Name.
Insured Name
Please provide a valid Insured Name.
Claimant Name
Please provide a valid Claimant Name.
Contact Information
Contact Person
Please provide a valid Contact Person.
Email
Invalid Email Address.
Mobile No.
Invalid Mobile No.
Preferred Contact Method
Email
Mail
IMPORTANT:
THIS eCLAIM FORM SHOULD BE SUBMITTED BY THE POLICYHOLDER / INSURED PERSON.
Claims Information
Are you insured with any other insurance as a result of the same incident?
Yes, please state details
No
Name of the Insurance Company
This field is required
Policy No.
This field is required
Claims Type
Loss of or damage to Contents / Stock
Business Interruption
Loss of Money
Public Liability
Personal Assault
Plate Glass
Employees' Compensation
Other(s)
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Domestic Helper
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