Home and Contents Claim Please state full details of what happened
Was the loss caused by a person other than yourself?
If Yes, please give name, address and telephone number of person causing the loss
(ii) Was damage caused by gaining entry?
If yes, what damage was caused
Police details (If burglary, theft, loss or malicious damage)
Has the loss been reported to the Police?
Was a list of missing items given to the Police?
Is there insurance with any other Company relating to this loss?
If yes, please give details below
Are you the sole owner of the property?
If no, please give details
eg. under joint ownership, mortgage, or hire purchase
Do you occupy the premises as the owner or tenant?
Were the premises occupied at the time of loss?
Have you made any other insurance claims over the last five years or have you or any member of your family ever had an insurance claim declined?
If yes, please give details below
Have you, or any member of your family living with you, ever been charged or convicted of any criminal offence other than driving offences?
If yes, please give details
Have you ever had an insurance policy declined, or had special terms imposed?
If yes, please give details below
Details of items being claimed for Take care - inflating your claim or adding extra items could see your total claim declined
Schedule A Items lost or damaged beyond repair. Click the + icon to add more.
Full description including make & model
New or secondhand
- Select - New Secondhand
Note: In the case of property lost or stolen we will require proof of ownership. To assist in settlement of such claims, please forward with the claim form the receipt, credit card slip or other document issued to you at the time of purchase. Copies of relevant receipts, creditcard slips or other supporting documents are attached.
Schedule B Items damaged but repairable. Click the + icon to add more.
Full description including make & model
Direct credit authority If your claim is accepted and there are payment(s) to you, we can pay this amount direct into your bank account by direct credit. If you would like us to make this direct credit, please complete the details below. You will be advised if a payment has been made following acceptance of your claim.
Do you wish to use this facility?
I/We authorise payment to be made into this bank account.
Signature of the Policyholder(s)
Submit
