Burglary Claim Form

1 Step 1
Insured Details
Policy Holder’s Name
Address
Cellphone
Homephone
Insured Details
Policy No.
Effective Date
date_range
Expiry Date
date_range
Risk Address
Loss Details
Date
date_range
Time
access_time
Location
Do you suspect any particular person?NB in cases of fire, the exact cause of the outbreak should be clearly stated.
0 /
Was the Loss or Damage reported to the Police?
Loss History
Have you had any previous Loss or made any claims for loss, theft or damage on any Insurer in the past 5 years?
Premises Information
Time
access_time
Were the premises securely locked?
How was entry gained?
Is the any other occupier of the premises?
Statement of Loss
Sum Insured
Are you the sole owner of the stolen property?
Are there any other insurances against this loss?
Upload Documents
cloud_uploadUpload

​Declaration *

I / We agree that if I/We have made or in any further declaration the Company may require in respect of the said incident, shall make any false or fraudulent statement, or any suppression or concealment, my/our claim shall be absolutely forfeited and the Policy shall be null and void and all rights to claim/recover there-under in respect of past or future loss/ incidents/accidents shall be forfeited

keyboard_arrow_leftPrevious
Nextkeyboard_arrow_right