To make a claim Claims Report 1 PROVIDE CLAIM DETAILS What is the Loss Date?* Date Format: MM slash DD slash YYYY Please enter the date of the loss What is the Estimated Value of the Loss?* What happened? Please describe the loss Additional Information 2 HOW DO WE CONTACT YOU? Contact Person First Last Email* Phone* Alternate Phone 3 PROVIDE THE POLICY DETAILS Name* First Last Location of Loss or Damage* Policy Number* Effective Date of Policy Date Format: MM slash DD slash YYYY Expiry Date of Policy Date Format: MM slash DD slash YYYY
