Miscellaneous Claim Online

Miscellaneous Claim Form

Name of Insured (required)

Physical Address (required)

Postal Address (required)

Mobile Number

Address where loss occured

Time of loss

Loss Date (required)

Describe fully how the loss occured

Details

Was the premises occupied?

If not when was it last occupied

Estimate the value of the damaged property

Is the the destroyed property insured on another policy?

If Yes State Insurer

Any additional Comments

Attach 3 Quotations from reputable garage below

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