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All Risks Claim Form ( Electronics & Other Items)


Please complete all questions as fully as possible
Policy Number
Insured’s Name Email
Telephone no Address
Has the property been stolen or damaged Address of the premises or place, where loss or damage occurred (If lost) from premises please state use of premises)
Full particulars of circumstances of the loss or damage

More Details

Date and time when loss or damage was discovered By whom discovered?
Date and time when articles(s) last seen By whom last seen and where?
When were the police notified, name of station, attending officer and report number? Has a thorough search been made for the article(s)
Have you ever before sustained previous Loss by theft? Loss of, or damage to, any article of value from any other cause? (if so, please state particulars)
Is the property for which you are claiming insured against Burglary, Theft Loss or Damage, with any other Company or underwriter? Was the property stolen from a car or unlocked premises? provide details
Are you the sole owner of the property? If not give the name of the owner.    
Full statement of claimed items to be provided overleaf
Date signature / Name of insured
The amount claimed will be limited to the sum insured, the intrinsic value at the time of the loss and any other terms of conditions of the policy. Where applicable details of damage and repair costs should be stated.
Description of article To whom the article belonged From whom purchased / received (address) purchase / received date Cost (pula) Depreciation