To make a claim Claims Report 1 PROVIDE CLAIM DETAILS2 HOW DO WE CONTACT YOU? 3 PROVIDE THE POLICY DETAILS What is the Loss Date?* Date Format: MM slash DD slash YYYY Please enter the date of the lossWhat is the Estimated Value of the Loss?*What happened? Please describe the lossAdditional Information Contact Person First Last Email* Phone*Alternate Phone 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
