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SUBMIT A CLAIM

INSURED

Region:

Name:

Address:

Cell No:

Tel No:

Fax No:

Email:

ID No:

VAT No:

LOSS/DAMAGE OCCURANCE

Date and Time of loss/damage:

When was loss/damage discovered?:

LOSS/DAMAGE PLACE

Place where loss/damage occurred:

(a)Were premises occupied?:

(b)By Whom?:

If not occupied when last occupied?:

Purpose of occupation: e.g. Office Space

CAUSE OF LOSS/DAMAGE

Describe fully how the loss or damage occurred stating how (if applicable) entry was gained to the premises:

If loss/damage caused by another party give name and address:

PREVIOUS LOSS/DAMAGE

Have you previously suffered a loss/damage?:

If so, give details:

If insured, provide name of insurer:

POLICE

Police Station:

Reference Number:

Date Reported:

OTHER INTEREST

Has any other party an interest in the insured property, e.g. Credit agreement:

If so, give name and interest:

OTHER INSURANCE

Is there any other insurance covering this loss?:

If so, give name of insurers:

VALUE

Estimated total of all the property, insured under the policy:

When last valued?:

PAYMENT METHOD

Name of bank:

Account Holder:

Branch Code:

Type of account:

Account number:

DECLARATION

I/We solemnly declare that I/we have suffered loss of or damage to the property enumerated and that the said property was in/my possession immediately prior to the said loss/damage which occurred in the circumstances described above.

Signature:

QTY	Description of Property	Date Acquired	Purchase Price	Amount Claimed
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OFFICE CONTENTS INSURANCE

Office contents insurance guards the everyday operational assets at your place of business – from stationery and staff personal effects (up to R2 500 per person) to furniture and loss of rent. Every little thing adds up, so make sure the sum insured under this cover is for the full replacement value.

When insuring your business you may also want to consider our specific policies related to electronic equipment, fire and allied perils and business all risks.

Please note:

•	Cover excludes electronic equipment such as computers, printers, copiers, etc. which must be insured separately.
•	Stock-trade and samples are also excluded.
•	Theft cover is subject to forcible entry and limited to 25% of the sum insured.
•	Documents (e.g. architectural plans, deeds, wills, legal documents, libraries, etc.) should be insured separately for full all risk cover, including legal liability for loss of documents.

To speak to one of our brokers, contact us on 031 242 6800, or fill in the Request a Quote form.