Submitted by mindq on Thu, 11/07/2019 - 08:06 Name of Insured Postal Address Email Address Policy Number Telephone No Mobile No Has the property been stolen or damaged? Stolen Damaged When was the theft, loss or damage discovered ? When was the theft, loss or damage discovered ?: Date When was the theft, loss or damage discovered ?: Time Who discovered the theft, loss or damage? Please describe the incident When and where was the property last seen by you? Who do you suspect? If the property was stolen or damaged Give the date that the police were informed Give the name of the Police Station Are you the sole owner of the property? Yes No Name of owner If the property in question is not specifically insured under the Policy but forms part of a miscellaneous category please state the present value of all the property covered under the same category and support this with 2 quotations. state the present value of all the property covered under the same category 2 supporting Quotations Maximum 2 files.512 MB limit.Allowed types: pdf. Is the property covered under any other insurance? If so please give full details. Yes No Have you sustained any previous losses by fire or theft? If so, please give full details together with the name of any Insurance Company dealing with the loss. CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
